Provider Demographics
NPI:1609569425
Name:CLAYTON, KATIE (SLPA125)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:SLPA125
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8313 CANYON TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-6240
Mailing Address - Country:US
Mailing Address - Phone:405-780-5877
Mailing Address - Fax:
Practice Address - Street 1:2015 N ASH ST STE 123
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1142
Practice Address - Country:US
Practice Address - Phone:580-304-9767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKSLPA1252355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant