Provider Demographics
NPI:1891708236
Name:STAUFFER, JANIS ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:ANN
Last Name:STAUFFER
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 1:4517 S PEORIA AVE
Mailing Address - Street 2:#11
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-4578
Mailing Address - Country:US
Mailing Address - Phone:918-850-0461
Mailing Address - Fax:918-743-5050
Practice Address - Street 1:4517 S PEORIA AVE
Practice Address - Street 2:#11
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-4578
Practice Address - Country:US
Practice Address - Phone:918-850-0461
Practice Address - Fax:918-743-5050
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist