Healthcare Provider Details

I. General information

NPI: 1548164395
Provider Name (Legal Business Name): VIVIAN FREEMAN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N FORREST ST
ALTUS OK
73521-2731
US

IV. Provider business mailing address

27558 N COUNTY ROAD 1990
GRANITE OK
73547-5294
US

V. Phone/Fax

Practice location:
  • Phone: 580-649-2925
  • Fax:
Mailing address:
  • Phone: 580-649-2925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6520
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: