Provider Demographics
NPI:1902985328
Name:QUILLIAN, SALLY LYNN (AUD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:LYNN
Last Name:QUILLIAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 NW EXPRESSWAY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7207
Mailing Address - Country:US
Mailing Address - Phone:405-947-4327
Mailing Address - Fax:405-947-4340
Practice Address - Street 1:2620 NW EXPRESSWAY ST
Practice Address - Street 2:SUITE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7207
Practice Address - Country:US
Practice Address - Phone:405-947-4327
Practice Address - Fax:405-947-4340
Is Sole Proprietor?:No
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK63231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731475099-001OtherSTATE DEPT. OF REHAB SERV