Provider Demographics
NPI:1205678315
Name:DEBERRY, MICHELE DIANE (EDD, MS CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:DIANE
Last Name:DEBERRY
Suffix:
Gender:F
Credentials:EDD, 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 1:1301 ANTLER RDG
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089-1803
Mailing Address - Country:US
Mailing Address - Phone:580-606-7111
Mailing Address - Fax:
Practice Address - Street 1:1301 ANTLER RDG
Practice Address - Street 2:
Practice Address - City:TUTTLE
Practice Address - State:OK
Practice Address - Zip Code:73089-1803
Practice Address - Country:US
Practice Address - Phone:580-606-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist