Healthcare Provider Details

I. General information

NPI: 1740196039
Provider Name (Legal Business Name): YVONNE DIRICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 NW FORT SILL BLVD
LAWTON OK
73507-5498
US

IV. Provider business mailing address

862 SE LASSO LOOP
LAWTON OK
73501-2029
US

V. Phone/Fax

Practice location:
  • Phone: 580-357-6900
  • Fax: 580-585-6319
Mailing address:
  • Phone: 580-351-7973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA467
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: