Provider Demographics
NPI:1669048179
Name:ROY, LESA (AUD)
Entity type:Individual
Prefix:
First Name:LESA
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SE HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2204
Mailing Address - Country:US
Mailing Address - Phone:918-333-0474
Mailing Address - Fax:918-333-5225
Practice Address - Street 1:205 SE HOWARD AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2204
Practice Address - Country:US
Practice Address - Phone:918-333-0474
Practice Address - Fax:918-333-5225
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-2993231H00000X
231H00000X
OK6020231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist