Healthcare Provider Details

I. General information

NPI: 1528206430
Provider Name (Legal Business Name): MARY LYNN CAMP HOLLIS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 COUNTRY CLUB RD
MCALESTER OK
74501-7231
US

IV. Provider business mailing address

1006 COUNTRY CLUB RD
MCALESTER OK
74501-7231
US

V. Phone/Fax

Practice location:
  • Phone: 918-470-4043
  • Fax:
Mailing address:
  • Phone: 918-470-4043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3218
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: