Provider Demographics
NPI:1033789409
Name:SKORODIN, ZOE (SLP)
Entity type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:SKORODIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N ASPEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1490
Mailing Address - Country:US
Mailing Address - Phone:918-550-5757
Mailing Address - Fax:918-505-7375
Practice Address - Street 1:2100 N ASPEN AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1490
Practice Address - Country:US
Practice Address - Phone:918-550-5757
Practice Address - Fax:918-505-7375
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCF679235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist