Provider Demographics
NPI:1477068674
Name:POPE, KAITLYN D (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:D
Last Name:POPE
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 E VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-7919
Mailing Address - Country:US
Mailing Address - Phone:405-377-8255
Mailing Address - Fax:405-835-3920
Practice Address - Street 1:814 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4225
Practice Address - Country:US
Practice Address - Phone:405-377-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-10
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4260235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1356746184Medicaid