Provider Demographics
NPI:1962103069
Name:PIAZZA, KINSAY BROOKE
Entity type:Individual
Prefix:
First Name:KINSAY
Middle Name:BROOKE
Last Name:PIAZZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S ELLIOTT ST STE C
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-6429
Mailing Address - Country:US
Mailing Address - Phone:918-825-4837
Mailing Address - Fax:918-825-4644
Practice Address - Street 1:510 S ELLIOTT ST STE C
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-6429
Practice Address - Country:US
Practice Address - Phone:918-825-4837
Practice Address - Fax:918-825-4644
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist