MEDICARE: CHRISSY R ANDERSON MSCCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	3536	OK

General Provider Information

NPI Number	:	1538466966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISSY R ANDERSON MSCCC/SLP

Provider Business Mailing Address
First Line	:	6161 S 33RD WEST AVE
Second Line	:	SUITE 105
City	:	TULSA
State	:	OK
Zip	:	74132-1527
Country	:	US
Telephone Number	:	918-398-7983
Fax Number	:

Provider Business Practice Location Address
First Line	:	6161 S 33RD WEST AVE
Second Line	:	SUITE 105
City	:	TULSA
State	:	OK
Zip	:	74132-1527
Country	:	US
Telephone Number	:	918-398-7983
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2011
Last Update Date	:	09/27/2011

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