MEDICARE: CARLYN JOHNSON HEINRICHS M.S, CCC-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	898	OK

General Provider Information

NPI Number	:	1255070157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLYN JOHNSON HEINRICHS M.S, CCC-SLP

Provider Business Mailing Address
First Line	:	13601 E 92ND ST N
Second Line	:
City	:	OWASSO
State	:	OK
Zip	:	74055-4558
Country	:	US
Telephone Number	:	918-346-4415
Fax Number	:

Provider Business Practice Location Address
First Line	:	3838 STATE ST STE 200
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2528
Country	:	US
Telephone Number	:	918-218-7280
Fax Number	:	833-840-6360

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

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	05/31/2022

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Directions to “ CARLYN JOHNSON HEINRICHS M.S, CCC-SLP” Practice Location

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