Provider Demographics
NPI:1841863966
Name:BRYANS, KAREN LEIGH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LEIGH
Last Name:BRYANS
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:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:MEDICINE PARK
Mailing Address - State:OK
Mailing Address - Zip Code:73557-0324
Mailing Address - Country:US
Mailing Address - Phone:940-210-5494
Mailing Address - Fax:
Practice Address - Street 1:107 GRANITE RIDGE CIRCLE
Practice Address - Street 2:
Practice Address - City:MEDICINE PARK
Practice Address - State:OK
Practice Address - Zip Code:73557-7355
Practice Address - Country:US
Practice Address - Phone:940-210-5494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5165235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist