Healthcare Provider Details

I. General information

NPI: 1154442374
Provider Name (Legal Business Name): MARY E BAHRUTH-POSKEY M.S.,C.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N 14TH ST
PONCA CITY OK
74601-2035
US

IV. Provider business mailing address

617 GREENBRIAR RD
PONCA CITY OK
74601-1622
US

V. Phone/Fax

Practice location:
  • Phone: 580-765-3321
  • Fax: 580-765-0203
Mailing address:
  • Phone: 580-762-6842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number342
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: