Healthcare Provider Details

I. General information

NPI: 1821371345
Provider Name (Legal Business Name): MEREDITH LEIGH SLISH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH LEIGH KEELING

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

V. Phone/Fax

Practice location:
  • Phone: 405-456-5183
  • Fax:
Mailing address:
  • Phone: 405-456-5183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0004349
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: