Provider Demographics
NPI:1053580811
Name:DICUS, JUDY KAY (MED CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:KAY
Last Name:DICUS
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 NW 109TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8028
Mailing Address - Country:US
Mailing Address - Phone:405-255-9428
Mailing Address - Fax:
Practice Address - Street 1:11200 NW 109TH ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8028
Practice Address - Country:US
Practice Address - Phone:405-255-9428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist