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General NPI Number Information
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NPI Number | 1194224766
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Entity Type | Individual
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Provider Name | FELICIA JO BRECHEISEN M.S, CF-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/08/2018
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Last Update Date | 02/08/2018
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Provider Practice Location Address
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Address Line | 825 E 3RD ST
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City | GROVE
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State | OK
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Zip | 74344-7973
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Country | US
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Telephone | 918-964-1921
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Fax |
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Provider Business Mailing Address
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Address Line | 13651 S 690 RD
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City | WYANDOTTE
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State | OK
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Zip | 74370-9332
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Country | US
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Telephone | 918-533-8895
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | CF4884
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License Number State | OK
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