# OKLAHOMA STATE DEPTARTMENT OF HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477009090
- **Authorized official:** MRS. JORDAN LEA BOLAY M.S.,CCC-SLP (SPEECH PATHOLOGIST)
- **Authorized official phone:** (580) 216-4321

## Contact information

- **Practice address:** 804 N. 7TH ST, PERRY, OK 73077
- **Practice address phone:** (580) 216-4321
- **Mailing address:** 804 N 7TH ST, PERRY, OK 73077-4230
- **Mailing address phone:** (580) 216-4321

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251K00000X | Public Health or Welfare Agency | 4013 | OK | Yes |

## Other

- **Enumeration date:** 09/01/2016
- **Last updated:** 09/01/2016