Provider Demographics
NPI:1659638153
Name:DENTON, KACEY LYNN (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KACEY
Middle Name:LYNN
Last Name:DENTON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11525 N MERIDIAN AVE
Mailing Address - Street 2:#203
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8050
Mailing Address - Country:US
Mailing Address - Phone:405-590-8342
Mailing Address - Fax:
Practice Address - Street 1:5534 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4006
Practice Address - Country:US
Practice Address - Phone:405-286-3749
Practice Address - Fax:866-435-3297
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3865235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist