Individual
BRYLEE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
307 E DANFORTH RD STE 130, EDMOND, OK 73034-4485
(405) 397-3550
Mailing address
10014 WOODLAND WAY, EDMOND, OK 73025-1431
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
CF442
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CF442
—
OK
Enumeration date
06/06/2022
Last updated
06/06/2022
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