Provider Demographics
NPI:1154151918
Name:MASON, BROOKLYN (SLPA)
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14324 290TH ST
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-6908
Mailing Address - Country:US
Mailing Address - Phone:405-626-7890
Mailing Address - Fax:
Practice Address - Street 1:184 SUMMER VALLEY RD
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-3140
Practice Address - Country:US
Practice Address - Phone:405-626-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3722355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant