Provider Demographics
NPI:1366740805
Name:GOLD BISON ENTERPRISES, P.C.
Entity type:Organization
Organization Name:GOLD BISON ENTERPRISES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MASHUNKASHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:918-766-1151
Mailing Address - Street 1:118 FLEETWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-8315
Mailing Address - Country:US
Mailing Address - Phone:918-766-1151
Mailing Address - Fax:918-333-3187
Practice Address - Street 1:6105 SE NOWATA ROAD
Practice Address - Street 2:SUITE 107
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-0000
Practice Address - Country:US
Practice Address - Phone:918-766-1151
Practice Address - Fax:918-335-3795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2734235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty