Provider Demographics
NPI:1902128242
Name:RODEBUSH, ROXANNE (MS CCC)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:RODEBUSH
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 S NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-6131
Mailing Address - Country:US
Mailing Address - Phone:918-406-5601
Mailing Address - Fax:
Practice Address - Street 1:3027 S NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-6131
Practice Address - Country:US
Practice Address - Phone:918-406-5601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3456235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist