Provider Demographics
NPI:1861500969
Name:TEFFT, DONITA R (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DONITA
Middle Name:R
Last Name:TEFFT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 E MARIE DR
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-1676
Mailing Address - Country:US
Mailing Address - Phone:580-402-2568
Mailing Address - Fax:405-744-8070
Practice Address - Street 1:042 MURRAY
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078-5062
Practice Address - Country:US
Practice Address - Phone:405-744-6021
Practice Address - Fax:405-744-8070
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200047620AMedicaid