Provider Demographics
NPI:1538466966
Name:ANDERSON, CHRISSY R (MSCCC/SLP)
Entity Type:Individual
Prefix:
First Name:CHRISSY
Middle Name:R
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 S 33RD WEST AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1527
Mailing Address - Country:US
Mailing Address - Phone:918-398-7983
Mailing Address - Fax:
Practice Address - Street 1:6161 S 33RD WEST AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1527
Practice Address - Country:US
Practice Address - Phone:918-398-7983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist