Provider Demographics
NPI:1316356769
Name:CHRISTOFFERSON, KENDALL KALAS (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:KALAS
Last Name:CHRISTOFFERSON
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:ELIZABETH
Other - Last Name:KALAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:921 NE 13TH ST RM 1F113
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5007
Mailing Address - Country:US
Mailing Address - Phone:405-456-5164
Mailing Address - Fax:405-456-4365
Practice Address - Street 1:921 NE 13TH ST RM 1F113
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5007
Practice Address - Country:US
Practice Address - Phone:405-456-5164
Practice Address - Fax:405-456-4365
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80832231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist