Provider Demographics
NPI:1245381516
Name:SLATER, SANDRA L (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:SLATER
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-0092
Mailing Address - Country:US
Mailing Address - Phone:918-647-9205
Mailing Address - Fax:
Practice Address - Street 1:1930 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2638
Practice Address - Country:US
Practice Address - Phone:918-649-0338
Practice Address - Fax:918-649-0331
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3221235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist