Provider Demographics
NPI:1598263840
Name:STEVENS, KAYLA STEPHANIE (MS/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:STEPHANIE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:STEPHANIE
Other - Last Name:WEDEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS/CCC-SLP
Mailing Address - Street 1:4908 S SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-5712
Mailing Address - Country:US
Mailing Address - Phone:918-740-1215
Mailing Address - Fax:
Practice Address - Street 1:4908 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-5712
Practice Address - Country:US
Practice Address - Phone:918-740-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4388235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist