Provider Demographics
NPI:1457773046
Name:ROSE, SHEILA KAYE (MED,CCC/SLP-L)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:KAYE
Last Name:ROSE
Suffix:
Gender:F
Credentials:MED,CCC/SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 PARKLAWN DR STE 10
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4213
Mailing Address - Country:US
Mailing Address - Phone:405-613-7036
Mailing Address - Fax:405-455-5988
Practice Address - Street 1:2828 PARKLAWN DR STE 10
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4213
Practice Address - Country:US
Practice Address - Phone:405-613-7036
Practice Address - Fax:405-455-5988
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist