Healthcare Provider Details

I. General information

NPI: 1962078139
Provider Name (Legal Business Name): KARISSA P. MARION-SMITH MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 09/01/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W. BOYD ST.
NORMAN OK
73069-4801
US

IV. Provider business mailing address

7601 LIPIZZAN RD
OKLAHOMA CITY OK
73132-0006
US

V. Phone/Fax

Practice location:
  • Phone: 405-366-7898
  • Fax: 405-366-0010
Mailing address:
  • Phone: 405-366-7898
  • Fax: 405-366-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCF332
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5726
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: