Provider Demographics
NPI:1881827632
Name:STATON, MARCY L (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:L
Last Name:STATON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E WHISPERING OAKS TER
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4870
Mailing Address - Country:US
Mailing Address - Phone:405-376-2669
Mailing Address - Fax:
Practice Address - Street 1:1100 E WHISPERING OAKS TER
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4870
Practice Address - Country:US
Practice Address - Phone:405-376-2669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3657235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist