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1505 Renaissance Blvd Edmond OK 73013-3018 | |
| (405) 850-8497 | |
| (405) 300-0643 |
| Full Name | |
|---|---|
| Speciality | Speech-language Pathologist |
| Location | 1505 Renaissance Blvd, Edmond, Oklahoma |
| Authorized Official Name and Position | Shea Nicole Parry (OWNER/PRESIDENT) |
| Authorized Official Contact | 4058508497 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1505 Renaissance Blvd Edmond OK 73013-3018 Ph: (405) 850-8497 | 1505 Renaissance Blvd Edmond OK 73013-3018 Ph: (405) 850-8497 |
| NPI Number | 1891218202 |
|---|---|
| Provider Enumeration Date | 07/18/2017 |
| Last Update Date | 08/08/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891218202 | NPI | - | NPPES |
| 200006740C | Medicaid | OK | |
| 2004714030A | Medicaid | OK | |
| 12040663 | Other | OK | SHEA PARRY M.ED., M.S. CCC-SLP |
| 1326194432 | Other | JOAN WIGGINS OTR | |
| 1043580830 | Other | DIANA DORETY MS CCC-SLP | |
| 1366694663 | Other | SHEA PARRY M.ED., M.S. CCC-SLP | |
| 100649180A | Medicaid | OK |
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