Provider Demographics
NPI:1144438805
Name:DOTSON, CINDY A (MEDCCC-SLP)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:A
Last Name:DOTSON
Suffix:
Gender:F
Credentials:MEDCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 S 257TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-4435
Mailing Address - Country:US
Mailing Address - Phone:918-357-5208
Mailing Address - Fax:
Practice Address - Street 1:320 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:STROUD
Practice Address - State:OK
Practice Address - Zip Code:74079-3641
Practice Address - Country:US
Practice Address - Phone:918-968-2656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist