Provider Demographics
NPI:1689702391
Name:UTTER, KRISTA A (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:A
Last Name:UTTER
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2210
Mailing Address - Country:US
Mailing Address - Phone:918-810-3850
Mailing Address - Fax:918-728-8036
Practice Address - Street 1:8110 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2210
Practice Address - Country:US
Practice Address - Phone:918-810-3850
Practice Address - Fax:918-728-8036
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist