Healthcare Provider Details

I. General information

NPI: 1720228760
Provider Name (Legal Business Name): STILLWATER HEARING CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W 8TH AVE
STILLWATER OK
74074-4602
US

IV. Provider business mailing address

116 W 8TH AVE
STILLWATER OK
74074-4602
US

V. Phone/Fax

Practice location:
  • Phone: 405-624-8605
  • Fax: 405-624-8606
Mailing address:
  • Phone: 405-624-8605
  • Fax: 405-624-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number103
License Number StateOK

VIII. Authorized Official

Name: MRS. JANET A THOMPSON
Title or Position: OWNER/AUDIOLOGIST
Credential: MA, FAAA
Phone: 405-624-8605