Provider Demographics
NPI:1982794442
Name:TEAGUE, WANDA ANN (MS, ED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:ANN
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:MS, ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT GIBSON
Mailing Address - State:OK
Mailing Address - Zip Code:74434
Mailing Address - Country:US
Mailing Address - Phone:918-348-2181
Mailing Address - Fax:
Practice Address - Street 1:500 SOUTH ROSS AVE.
Practice Address - Street 2:
Practice Address - City:FORT GIBSON
Practice Address - State:OK
Practice Address - Zip Code:74434
Practice Address - Country:US
Practice Address - Phone:918-348-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist