Provider Demographics
NPI:1629402581
Name:BURNS, KATHLEEN (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8524 S WESTERN AVE
Mailing Address - Street 2:SUITE 111 STONEY CREEK OFFICE PARK,
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9246
Mailing Address - Country:US
Mailing Address - Phone:405-702-9396
Mailing Address - Fax:
Practice Address - Street 1:8524 S WESTERN AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9246
Practice Address - Country:US
Practice Address - Phone:405-702-9396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist