Individual
CICELY FANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2208 N YELLOWOOD AVE, BROKEN ARROW, OK 74012-9102
(918) 286-1261
Mailing address
2208 N YELLOWOOD AVE, BROKEN ARROW, OK 74012-9102
(918) 286-1261
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12094555
OK
Other
Enumeration date
10/03/2006
Last updated
07/08/2007
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