Provider Demographics
NPI:1265159156
Name:ESTRADA, SANDRA YVETTE (SLPA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:YVETTE
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 COUNTY STREET 2980
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-4235
Mailing Address - Country:US
Mailing Address - Phone:405-824-5439
Mailing Address - Fax:
Practice Address - Street 1:400 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-5529
Practice Address - Country:US
Practice Address - Phone:405-779-3270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKSLPA1352355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant