Provider Demographics
NPI:1508517186
Name:STORY, AVERY (PROGRAM DIRECTOR SLP)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:STORY
Suffix:
Gender:F
Credentials:PROGRAM DIRECTOR SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10619 S NATHAN ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-1821
Mailing Address - Country:US
Mailing Address - Phone:918-822-2554
Mailing Address - Fax:
Practice Address - Street 1:6800 S GRANITE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7039
Practice Address - Country:US
Practice Address - Phone:918-822-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4542235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist