Provider Demographics
NPI:1629551973
Name:FRY, CHELSEY R (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:R
Last Name:FRY
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:PO BOX 1956
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74076-1956
Mailing Address - Country:US
Mailing Address - Phone:405-564-2701
Mailing Address - Fax:888-581-6850
Practice Address - Street 1:120 N PERKINS RD STE F
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-5524
Practice Address - Country:US
Practice Address - Phone:405-564-2701
Practice Address - Fax:888-581-6850
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4548235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4548OtherSTATE LICENSE