Healthcare Provider Details

I. General information

NPI: 1245142934
Provider Name (Legal Business Name): EMILY SUE GOTTLOB MS., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W 141ST ST
GLENPOOL OK
74033-3555
US

IV. Provider business mailing address

140 W 141ST ST
GLENPOOL OK
74033-3555
US

V. Phone/Fax

Practice location:
  • Phone: 918-322-9500
  • Fax: 918-322-1529
Mailing address:
  • Phone: 918-322-9500
  • Fax: 918-322-1529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6621
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: