Provider Demographics
NPI:1265612881
Name:BRAZIEL, ALISSA ANNE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:ANNE
Last Name:BRAZIEL
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 1:305 S 5TH ST
Mailing Address - Street 2:REHABCARE AT ST. MARY'S REGIONAL MEDICAL CTR
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5832
Mailing Address - Country:US
Mailing Address - Phone:580-548-5075
Mailing Address - Fax:
Practice Address - Street 1:305 S 5TH ST
Practice Address - Street 2:REHABCARE AT ST. MARY'S REGIONAL MEDICAL CTR
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5832
Practice Address - Country:US
Practice Address - Phone:580-548-5075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3067235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist