Healthcare Provider Details

I. General information

NPI: 1205366390
Provider Name (Legal Business Name): CYNTHIA FALLON MCCOOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 COMMONS CIRCLE SUITE B
YUKON OK
73099
US

IV. Provider business mailing address

204 N CLAYTON RD
EDMOND OK
73034-7380
US

V. Phone/Fax

Practice location:
  • Phone: 405-467-6782
  • Fax:
Mailing address:
  • Phone: 214-773-4913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4280
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number4280
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: