Individual
MRS. TARA SUZANNE WYSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
2244 E SHAWNEE BYP, MUSKOGEE, OK 74403-1446
(918) 684-9999
(888) 663-4223
Mailing address
2244 E SHAWNEE BYP, MUSKOGEE, OK 74403-1446
(918) 684-9999
(888) 663-4223
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4877
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200823950A
—
OK
Enumeration date
10/25/2016
Last updated
02/02/2022
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