Provider Demographics
NPI:1639612435
Name:NEWBY, STARLA DIANE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STARLA
Middle Name:DIANE
Last Name:NEWBY
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 1709
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-1709
Mailing Address - Country:US
Mailing Address - Phone:580-221-3001
Mailing Address - Fax:
Practice Address - Street 1:615 STANLEY ST SW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-4717
Practice Address - Country:US
Practice Address - Phone:580-223-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist