Healthcare Provider Details

I. General information

NPI: 1851030589
Provider Name (Legal Business Name): MYKAH JO ESHBAUGH SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W TECUMSEH RD STE 103
NORMAN OK
73072-1810
US

IV. Provider business mailing address

PO BOX 1330
NORMAN OK
73070-1330
US

V. Phone/Fax

Practice location:
  • Phone: 405-515-8080
  • Fax:
Mailing address:
  • Phone: 405-307-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6724
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: