Healthcare Provider Details

I. General information

NPI: 1134043011
Provider Name (Legal Business Name): LINZY JORDON DILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S MAIN ST
BROKEN ARROW OK
74012-5528
US

IV. Provider business mailing address

15170 S 291ST EAST AVE
COWETA OK
74429-2224
US

V. Phone/Fax

Practice location:
  • Phone: 918-259-5784
  • Fax: 918-251-0689
Mailing address:
  • Phone: 918-259-5784
  • Fax: 918-251-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: