Provider Demographics
NPI:1245452143
Name:POGUE, MARQUITA K (MACCCSLP)
Entity type:Individual
Prefix:MS
First Name:MARQUITA
Middle Name:K
Last Name:POGUE
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S. NARCISSUS AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-4926
Mailing Address - Country:US
Mailing Address - Phone:918-284-0250
Mailing Address - Fax:
Practice Address - Street 1:6525 N. MERIDIAN
Practice Address - Street 2:SUITE 311
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116
Practice Address - Country:US
Practice Address - Phone:405-721-1115
Practice Address - Fax:405-721-2025
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2856235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist