Healthcare Provider Details

I. General information

NPI: 1811260359
Provider Name (Legal Business Name): MELINDA LEE FISHER-WILKIN MSC SLT, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6960 FOXBRIAR DR
TULSA OK
74132-1003
US

IV. Provider business mailing address

6960 FOXBRIAR DR
TULSA OK
74132-1003
US

V. Phone/Fax

Practice location:
  • Phone: 918-630-0296
  • Fax:
Mailing address:
  • Phone: 918-630-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-9255
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: