Provider Demographics
NPI:1386904480
Name:HYLAND, JULIE CARLSON (AUD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:CARLSON
Last Name:HYLAND
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 S HARVARD AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2620
Mailing Address - Country:US
Mailing Address - Phone:918-508-7601
Mailing Address - Fax:918-508-7602
Practice Address - Street 1:4415 S HARVARD AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2620
Practice Address - Country:US
Practice Address - Phone:918-508-7601
Practice Address - Fax:918-508-7602
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3899231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200431510AMedicaid
OKA104520Medicare UPIN