Healthcare Provider Details

I. General information

NPI: 1386199073
Provider Name (Legal Business Name): TERRI POGUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERRI LYNN POGUE

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 S 530 RD
MIAMI OK
74354-6035
US

IV. Provider business mailing address

10700 S 530 RD
MIAMI OK
74354-6035
US

V. Phone/Fax

Practice location:
  • Phone: 918-207-7913
  • Fax:
Mailing address:
  • Phone: 918-207-7913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12077988
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: