Provider Demographics
NPI:1376181180
Name:LEJEUNE, KRISTIN (SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:LEJEUNE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-2328
Mailing Address - Country:US
Mailing Address - Phone:405-850-9713
Mailing Address - Fax:
Practice Address - Street 1:3308 DOGWOOD LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-2328
Practice Address - Country:US
Practice Address - Phone:405-850-9713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK710235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist