Provider Demographics
NPI:1821732389
Name:ROLPH, MICHAELA ELAINE (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:ELAINE
Last Name:ROLPH
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:ELAINE
Other - Last Name:WIGGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12731 N 3990 RD
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:OK
Mailing Address - Zip Code:74029-4011
Mailing Address - Country:US
Mailing Address - Phone:918-688-8305
Mailing Address - Fax:
Practice Address - Street 1:12731 N 3990 RD
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:OK
Practice Address - Zip Code:74029-4011
Practice Address - Country:US
Practice Address - Phone:918-688-8305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist