Provider Demographics
NPI:1710065263
Name:CHARLTON, KATRINA ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:ANN
Last Name:CHARLTON
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 1:5022 E 88TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2910
Mailing Address - Country:US
Mailing Address - Phone:918-481-5791
Mailing Address - Fax:
Practice Address - Street 1:7112 S MINGO RD
Practice Address - Street 2:SUITE 108
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3201
Practice Address - Country:US
Practice Address - Phone:918-250-7093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist