Provider Demographics
NPI:1609942796
Name:GIFFORD, RENE H (PHD)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:H
Last Name:GIFFORD
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:RENE
Other - Middle Name:H
Other - Last Name:HEADRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-936-2000
Mailing Address - Fax:
Practice Address - Street 1:11500 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4625
Practice Address - Country:US
Practice Address - Phone:405-548-4300
Practice Address - Fax:405-548-4350
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6375231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN111600000Medicaid