Provider Demographics
NPI:1548349079
Name:SMITH, HEATHER RUTH (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RUTH
Last Name:SMITH
Suffix:
Gender:F
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 1:13795 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-3255
Mailing Address - Country:US
Mailing Address - Phone:918-291-2491
Mailing Address - Fax:
Practice Address - Street 1:7112 S MINGO RD STE 108
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3267
Practice Address - Country:US
Practice Address - Phone:918-250-7093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12127772OtherASHA ACCOUNT NUMBER