Provider Demographics
NPI:1619329836
Name:OSMUS, LISA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:OSMUS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CF-SLP
Mailing Address - Street 1:4157 S HARVARD AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2606
Mailing Address - Country:US
Mailing Address - Phone:918-712-7868
Mailing Address - Fax:918-878-7920
Practice Address - Street 1:4157 S HARVARD AVE STE 117
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2606
Practice Address - Country:US
Practice Address - Phone:918-712-7868
Practice Address - Fax:918-878-7920
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist