Healthcare Provider Details

I. General information

NPI: 1235625971
Provider Name (Legal Business Name): MADISON TAELOR PLUNK M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON TAELOR WELLS M.A., CCC-SLP

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 SW 84TH ST
OKLAHOMA CITY OK
73139-9255
US

IV. Provider business mailing address

537 LONE OAK DR
NORMAN OK
73071-2166
US

V. Phone/Fax

Practice location:
  • Phone: 405-636-0626
  • Fax:
Mailing address:
  • Phone: 580-704-6234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4506
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: