Provider Demographics
NPI:1871879163
Name:NELSON, LINDA RAE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:RAE
Last Name:NELSON
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 1:950507 S HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-4244
Mailing Address - Country:US
Mailing Address - Phone:405-258-2839
Mailing Address - Fax:
Practice Address - Street 1:8524 S WESTERN AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9246
Practice Address - Country:US
Practice Address - Phone:405-702-9396
Practice Address - Fax:405-702-9397
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist