Provider Demographics
NPI:1457518797
Name:GUDGEL, DANA (MA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:GUDGEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4629 S HARVARD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2946
Mailing Address - Country:US
Mailing Address - Phone:918-698-5561
Mailing Address - Fax:918-398-7983
Practice Address - Street 1:4629 S HARVARD AVE STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2946
Practice Address - Country:US
Practice Address - Phone:918-698-5561
Practice Address - Fax:918-398-7983
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3708235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist