Healthcare Provider Details

I. General information

NPI: 1346826971
Provider Name (Legal Business Name): JUDY G HASSOUN MS CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18824 COMMONS CIRCLE, SUITE B
YUKON OK
73099
US

IV. Provider business mailing address

18824 COMMONS CIRCLE, SUITE B
YUKON OK
73099
US

V. Phone/Fax

Practice location:
  • Phone: 45-324-0961
  • Fax:
Mailing address:
  • Phone: 45-324-0961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCF208
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: