Provider Demographics
NPI:1851837637
Name:JACKSON-BRYANT, NANCY BETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:BETH
Last Name:JACKSON-BRYANT
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 1:7502 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-6417
Mailing Address - Country:US
Mailing Address - Phone:918-706-0823
Mailing Address - Fax:
Practice Address - Street 1:2819 S NEW HAVEN AVE
Practice Address - Street 2:TULSA PUBLIC SCHOOLS ENROLLMENT CENTER
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114
Practice Address - Country:US
Practice Address - Phone:918-746-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist