Provider Demographics
NPI:1629005848
Name:GALBRAITH, MARLA JEAN (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:JEAN
Last Name:GALBRAITH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 LONG BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-7940
Mailing Address - Country:US
Mailing Address - Phone:405-285-6765
Mailing Address - Fax:405-285-5403
Practice Address - Street 1:301 S BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3878
Practice Address - Country:US
Practice Address - Phone:405-285-6765
Practice Address - Fax:405-285-5403
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100674520AMedicaid
OK100674520CMedicaid