Provider Demographics
NPI:1336569656
Name:WESTHOFF, ANNA NICOLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:NICOLE
Last Name:WESTHOFF
Suffix:
Gender:F
Credentials: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:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:KELLYVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74039-0099
Mailing Address - Country:US
Mailing Address - Phone:918-247-6300
Mailing Address - Fax:
Practice Address - Street 1:144 S. ELM
Practice Address - Street 2:
Practice Address - City:KELLYVILLE
Practice Address - State:OK
Practice Address - Zip Code:74039
Practice Address - Country:US
Practice Address - Phone:918-247-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4207235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist