Provider Demographics
NPI:1760922090
Name:BUSSEY, DANELL (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANELL
Middle Name:
Last Name:BUSSEY
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 1:4157 S HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2631
Mailing Address - Country:US
Mailing Address - Phone:918-712-7868
Mailing Address - Fax:918-878-7920
Practice Address - Street 1:4157 S HARVARD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2631
Practice Address - Country:US
Practice Address - Phone:918-712-7868
Practice Address - Fax:918-878-7920
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist