Provider Demographics
NPI:1962078139
Name:MARION-SMITH, KARISSA P (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KARISSA
Middle Name:P
Last Name:MARION-SMITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 LIPIZZAN RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-0006
Mailing Address - Country:US
Mailing Address - Phone:405-366-7898
Mailing Address - Fax:405-366-0010
Practice Address - Street 1:1201 W. BOYD ST.
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4801
Practice Address - Country:US
Practice Address - Phone:405-366-7898
Practice Address - Fax:405-366-0010
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCF332235Z00000X
OK5726235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200988050AMedicaid