Provider Demographics
NPI:1376603902
Name:FRY, MINDY S (AUD)
Entity Type:Individual
Prefix:MS
First Name:MINDY
Middle Name:S
Last Name:FRY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7614 E 91ST ST
Mailing Address - Street 2:STE 160
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6047
Mailing Address - Country:US
Mailing Address - Phone:918-493-3133
Mailing Address - Fax:918-493-2322
Practice Address - Street 1:7614 E 91ST ST
Practice Address - Street 2:STE 160
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6047
Practice Address - Country:US
Practice Address - Phone:918-493-3133
Practice Address - Fax:918-493-2322
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK319231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK700079Medicare PIN