Provider Demographics
NPI:1578350237
Name:BRONN, STACY (SLP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:BRONN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:
Other - Last Name:BRONN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:7312 NW 114TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2703
Mailing Address - Country:US
Mailing Address - Phone:405-474-4227
Mailing Address - Fax:
Practice Address - Street 1:7301 N SARA RD
Practice Address - Street 2:SUITE 120
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099
Practice Address - Country:US
Practice Address - Phone:405-982-2086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6378235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist