Provider Demographics
NPI:1740565712
Name:HEADRICK, KAY (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KAY
Middle Name:
Last Name:HEADRICK
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:P. O. BOX 2373
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74076
Mailing Address - Country:US
Mailing Address - Phone:918-232-1695
Mailing Address - Fax:
Practice Address - Street 1:042 MURRAY
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078-5062
Practice Address - Country:US
Practice Address - Phone:405-744-6021
Practice Address - Fax:405-744-8070
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2294235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist