Kristin Bresciano, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

3127 Issued in OK

Practice address

2221 W Detroit St
Broken Arrow, OK 74012-3628

Phone

(918) 615-6492

NPI assigned

Nov 7, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Collaborative Therapy Services Inc

  • Multi-Specialty Clinic/Center
  • Broken Arrow, OK
  • NPI 1932344835
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242604800000",
    "number": "1821167743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 W DETROIT ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740123628",
            "telephone_number": "918-615-6492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2221 W DETROIT ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740123628",
            "telephone_number": "918-615-6492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRESCIANO",
        "first_name": "KRISTIN",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-07",
        "last_updated": "2009-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OK",
            "license": "3127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200076310A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Speech-Language Pathologist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.