Active NPI
Laura Jean Duppong, M. ED., CCC-SLP
- Speech-Language Pathologist
- Broken Arrow, OK
National Provider Identifier
1225115983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2917
- Practice address
- 801 S Main St
Broken Arrow, OK 74012-5530 - Phone
- (918) 259-5784
- Fax
- (918) 251-0689
- NPI assigned
- Nov 1, 2006
- Last updated
- Jun 7, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2917 | OK | Primary |
Addresses
Primary practice location
801 S Main St
Broken Arrow, OK 74012-5530
Mailing address
701 S Main St
Broken Arrow, OK 74012-5528
Phone (918) 259-5784
Other practice location 1
7328 E 81st Pl
Tulsa, OK 74133-4223
Phone (918) 381-5492
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Y 200062210A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2917 | OK | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapysource for Kids, Inc. | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba TherapyTown
- Hearing and Speech Clinic/Center
- Tulsa, OK
- NPI 1447395033
Speech-Language Pathologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686096000000",
"number": "1225115983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 S MAIN ST",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740125528",
"telephone_number": "918-259-5784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 S MAIN ST",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740125530",
"telephone_number": "918-259-5784",
"fax_number": "918-251-0689"
}
],
"practiceLocations": [
{
"address_1": "7328 E 81st Pl",
"address_purpose": "LOCATION",
"city": "Tulsa",
"state": "OK",
"postal_code": "741334223",
"country_code": "US",
"telephone_number": "918-381-5492",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DUPPONG",
"first_name": "LAURA",
"middle_name": "JEAN",
"name_prefix": "Ms.",
"credential": "M. ED., CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2023-06-07",
"certification_date": "2023-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OK",
"license": "2917",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "Y 200062210A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Broken Arrow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.