Provider Demographics
NPI:1205071644
Name:POINDEXTER, JOELLEN TOMLINSON (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JOELLEN
Middle Name:TOMLINSON
Last Name:POINDEXTER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:JOELLEN
Other - Middle Name:LYN
Other - Last Name:TOMLINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:11220 N ROCKWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2725
Mailing Address - Country:US
Mailing Address - Phone:405-722-6731
Mailing Address - Fax:405-722-9463
Practice Address - Street 1:11208 STURBRIDGE RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-2162
Practice Address - Country:US
Practice Address - Phone:405-721-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200224950AMedicaid
OK200102340AMedicaid