Provider Demographics
NPI:1578640579
Name:MORTON, KATHY AMELIA (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:AMELIA
Last Name:MORTON
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:MISS
Other - First Name:KATHY
Other - Middle Name:AMELIA
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CFSLP
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-0388
Mailing Address - Country:US
Mailing Address - Phone:405-760-6106
Mailing Address - Fax:405-720-3501
Practice Address - Street 1:11220 N ROCKWELL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-2725
Practice Address - Country:US
Practice Address - Phone:405-760-6106
Practice Address - Fax:405-720-3501
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200085140AMedicaid