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NPI Code Detail

MEDICARE: MS. SHANUN MICAELA GIBSON M.S.,CCC/SLP

MEDICARE: MS. SHANUN MICAELA GIBSON M.S.,CCC/SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist3335OK

General Provider Information

NPI Number : 1003087578
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHANUN MICAELA GIBSON M.S.,CCC/SLP
Provider Business Mailing Address
First Line : 9031 SW 29TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73179-2818
Country : US
Telephone Number : 405-732-3946
Fax Number : 405-261-6311
Provider Business Practice Location Address
First Line : 9031 SW 29TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73179-2818
Country : US
Telephone Number : 405-732-3946
Fax Number : 405-261-6311
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2008
Last Update Date : 03/24/2022

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