Individual
KIM ELLEN BRUNETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
13720 CALISTOGA DR, OKLAHOMA CITY, OK 73170-5113
(405) 552-2799
(405) 553-5668
Mailing address
13720 CALISTOGA DR, OKLAHOMA CITY, OK 73170-5113
(405) 552-2799
(405) 553-5668
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
418
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100670690A
—
OK
01
—
736017987116
DEPT OF REHAB
OK
Enumeration date
10/24/2005
Last updated
02/05/2009
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