Provider Demographics
NPI:1093440117
Name:BARDELAS, KRISTEN COMAS (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:COMAS
Last Name:BARDELAS
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 1:1527 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-3815
Mailing Address - Country:US
Mailing Address - Phone:786-294-3936
Mailing Address - Fax:
Practice Address - Street 1:1527 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-3815
Practice Address - Country:US
Practice Address - Phone:786-294-3936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
OKSP6206235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist