Provider Demographics
NPI:1588172597
Name:DEATON, TINA SABRINA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:SABRINA
Last Name:DEATON
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 1:3916 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4032
Mailing Address - Country:US
Mailing Address - Phone:405-623-3436
Mailing Address - Fax:
Practice Address - Street 1:3916 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4032
Practice Address - Country:US
Practice Address - Phone:405-623-3436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist