MEDICARE: TERRI BOSNYAK 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	3486	OK

General Provider Information

NPI Number	:	1811610447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI BOSNYAK M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	4401 W MEMORIAL RD STE 125
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1787
Country	:	US
Telephone Number	:	405-752-3060
Fax Number	:	405-752-3189

Provider Business Practice Location Address
First Line	:	4401 W MEMORIAL RD STE 125
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1787
Country	:	US
Telephone Number	:	405-752-3060
Fax Number	:	405-752-3189

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

Provider Enumeration Date	:	09/20/2022
Last Update Date	:	09/20/2022

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