Provider Demographics
NPI:1881945707
Name:BOSS, TRISHA JOAN
Entity type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:JOAN
Last Name:BOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 CANYON TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-6240
Mailing Address - Country:US
Mailing Address - Phone:405-317-6140
Mailing Address - Fax:405-702-9397
Practice Address - Street 1:8524 S WESTERN AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9246
Practice Address - Country:US
Practice Address - Phone:405-640-7045
Practice Address - Fax:405-702-9397
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist