MEDICARE: KAREN LEIGH BRYANS MS, 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	5165	OK

General Provider Information

NPI Number	:	1841863966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LEIGH BRYANS MS, CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 324
Second Line	:
City	:	MEDICINE PARK
State	:	OK
Zip	:	73557-0324
Country	:	US
Telephone Number	:	940-210-5494
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 GRANITE RIDGE CIRCLE
Second Line	:
City	:	MEDICINE PARK
State	:	OK
Zip	:	73557-7355
Country	:	US
Telephone Number	:	940-210-5494
Fax Number	:

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

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	07/19/2021

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