Provider Demographics
NPI:1831496256
Name:CALVERT, LOUISA NICOLE (SLP)
Entity Type:Individual
Prefix:
First Name:LOUISA
Middle Name:NICOLE
Last Name:CALVERT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LOUISA
Other - Middle Name:NICOLE
Other - Last Name:REECE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1405 4TH AVE NW # 296
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2708
Mailing Address - Country:US
Mailing Address - Phone:580-795-4561
Mailing Address - Fax:
Practice Address - Street 1:3701 N MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-6450
Practice Address - Country:US
Practice Address - Phone:918-425-8932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3410235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist