Provider Demographics
NPI:1730583584
Name:FREEL, AMANDA GAYLE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GAYLE
Last Name:FREEL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 BUFFALO PASS
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-1541
Mailing Address - Country:US
Mailing Address - Phone:918-931-2869
Mailing Address - Fax:
Practice Address - Street 1:2217 BUFFALO PASS
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-1541
Practice Address - Country:US
Practice Address - Phone:918-931-2869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3247235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist