Healthcare Provider Details

I. General information

NPI: 1659580512
Provider Name (Legal Business Name): SHELLY DEANN GEDDES M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4331 ADAMS RD STE 111
NORMAN OK
73069-1007
US

IV. Provider business mailing address

1810 MARYMOUNT RD
NORMAN OK
73071-3948
US

V. Phone/Fax

Practice location:
  • Phone: 405-438-0090
  • Fax: 405-493-0717
Mailing address:
  • Phone: 405-990-9417
  • Fax: 405-493-0717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3288
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: