Provider Demographics
NPI:1194224766
Name:BRECHEISEN, FELICIA JO (MS, CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:JO
Last Name:BRECHEISEN
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13651 S 690 RD
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:OK
Mailing Address - Zip Code:74370-9332
Mailing Address - Country:US
Mailing Address - Phone:918-533-8895
Mailing Address - Fax:
Practice Address - Street 1:825 E 3RD ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-7973
Practice Address - Country:US
Practice Address - Phone:918-964-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCF4884235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist