Provider Demographics
NPI:1023590361
Name:ANNETT, MEGAN RAYE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:RAYE
Last Name:ANNETT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:RAYE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1146 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-4614
Mailing Address - Country:US
Mailing Address - Phone:918-706-3156
Mailing Address - Fax:
Practice Address - Street 1:3712 E 83RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-1703
Practice Address - Country:US
Practice Address - Phone:918-704-2760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1992210256Medicaid