Provider Demographics
NPI:1114290715
Name:ARNOLD, KRISTEN RENEE (CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:RENEE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 SW BRADFORD LN
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5011
Mailing Address - Country:US
Mailing Address - Phone:580-704-6384
Mailing Address - Fax:
Practice Address - Street 1:4121 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6336
Practice Address - Country:US
Practice Address - Phone:580-353-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3796235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist