Provider Demographics
NPI:1255070157
Name:HEINRICHS, CARLYN JOHNSON (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARLYN
Middle Name:JOHNSON
Last Name:HEINRICHS
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 1:13601 E 92ND ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4558
Mailing Address - Country:US
Mailing Address - Phone:918-346-4415
Mailing Address - Fax:
Practice Address - Street 1:3838 STATE ST STE 200
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2528
Practice Address - Country:US
Practice Address - Phone:918-218-7280
Practice Address - Fax:833-840-6360
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK898235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist