Provider Demographics
NPI:1578719530
Name:BURNS, JOAN M (MA,CCC-A)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:BURNS
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6802 S OLYMPIA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1826
Mailing Address - Country:US
Mailing Address - Phone:918-388-9740
Mailing Address - Fax:918-388-9741
Practice Address - Street 1:6802 S OLYMPIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1826
Practice Address - Country:US
Practice Address - Phone:918-388-9740
Practice Address - Fax:918-388-9741
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK72231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100677070AMedicaid