Provider Demographics
NPI:1386523660
Name:COFFEY, FAITH NICOLE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:NICOLE
Last Name:COFFEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:FAITH
Other - Middle Name:NICOLE
Other - Last Name:WICKLIFFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:14065 W 81ST ST S
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-8156
Mailing Address - Country:US
Mailing Address - Phone:918-630-6545
Mailing Address - Fax:
Practice Address - Street 1:14065 W 81ST ST S
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-8156
Practice Address - Country:US
Practice Address - Phone:918-630-6545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12144235Z00000X
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty