Healthcare Provider Details

I. General information

NPI: 1790476018
Provider Name (Legal Business Name): SAMANTHA MCCORNACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W BOYD ST
NORMAN OK
73069-4801
US

IV. Provider business mailing address

1201 W BOYD ST
NORMAN OK
73069-4801
US

V. Phone/Fax

Practice location:
  • Phone: 405-366-7898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: