Provider Demographics
NPI:1750410379
Name:YUKON PUBLIC
Entity type:Organization
Organization Name:YUKON PUBLIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-350-1341
Mailing Address - Street 1:600 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2533
Mailing Address - Country:US
Mailing Address - Phone:405-350-1341
Mailing Address - Fax:
Practice Address - Street 1:600 MAPLE ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2533
Practice Address - Country:US
Practice Address - Phone:405-350-1341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251K00000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty