Provider Demographics
NPI:1538582705
Name:BURRIS, DIANN (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DIANN
Middle Name:
Last Name:BURRIS
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12016 SW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-7223
Mailing Address - Country:US
Mailing Address - Phone:405-830-4023
Mailing Address - Fax:405-324-5536
Practice Address - Street 1:1100 N MUSTANG RD
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-7201
Practice Address - Country:US
Practice Address - Phone:405-830-4023
Practice Address - Fax:405-324-5536
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2837235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist