Provider Demographics
NPI:1760863971
Name:GARY, DELAYNA RENEE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DELAYNA
Middle Name:RENEE
Last Name:GARY
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 1:209 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-5521
Mailing Address - Country:US
Mailing Address - Phone:405-623-2047
Mailing Address - Fax:
Practice Address - Street 1:14 E AYERS ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3667
Practice Address - Country:US
Practice Address - Phone:405-513-8186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4395235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist