Provider Demographics
NPI:1801994025
Name:GENTRY, DAVID W (CCC/SLP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:GENTRY
Suffix:
Gender:M
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49167 140TH ST
Mailing Address - Street 2:
Mailing Address - City:BYARS
Mailing Address - State:OK
Mailing Address - Zip Code:74831-7305
Mailing Address - Country:US
Mailing Address - Phone:580-759-6424
Mailing Address - Fax:580-759-3396
Practice Address - Street 1:49167 140TH ST
Practice Address - Street 2:
Practice Address - City:BYARS
Practice Address - State:OK
Practice Address - Zip Code:74831-7305
Practice Address - Country:US
Practice Address - Phone:580-759-6424
Practice Address - Fax:580-759-3396
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2719235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist