Provider Demographics
NPI:1801416268
Name:RAINS, KALLY LANE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KALLY
Middle Name:LANE
Last Name:RAINS
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 1:106393 S 4720 RD
Mailing Address - Street 2:
Mailing Address - City:MULDROW
Mailing Address - State:OK
Mailing Address - Zip Code:74948-7236
Mailing Address - Country:US
Mailing Address - Phone:479-353-0513
Mailing Address - Fax:
Practice Address - Street 1:715 E SHAWNTEL SMITH BLVD
Practice Address - Street 2:
Practice Address - City:MULDROW
Practice Address - State:OK
Practice Address - Zip Code:74948-7494
Practice Address - Country:US
Practice Address - Phone:918-427-7406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-25
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty