Provider Demographics
NPI:1023150190
Name:ACEBO, LYNETTE RAE (MS CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:LYNETTE
Middle Name:RAE
Last Name:ACEBO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3801
Mailing Address - Country:US
Mailing Address - Phone:918-645-3020
Mailing Address - Fax:918-298-5336
Practice Address - Street 1:510 N DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3801
Practice Address - Country:US
Practice Address - Phone:918-645-3020
Practice Address - Fax:918-298-5336
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist