Provider Demographics
NPI:1710904438
Name:BANDL, DENISE (MS, CCC-SLP, ATP)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:BANDL
Suffix:
Gender:F
Credentials:MS, CCC-SLP, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 CHICKASAW RD
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-6865
Mailing Address - Country:US
Mailing Address - Phone:918-695-2672
Mailing Address - Fax:866-516-8160
Practice Address - Street 1:1071 CHICKASAW RD
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-6865
Practice Address - Country:US
Practice Address - Phone:918-494-0190
Practice Address - Fax:866-516-8160
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100656260AMedicaid