Provider Demographics
NPI:1821586694
Name:KONARIK, KAITLYN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:KONARIK
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 1:14715 BRISTOL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1894
Mailing Address - Country:US
Mailing Address - Phone:405-840-1686
Mailing Address - Fax:405-840-1686
Practice Address - Street 1:12899 E 76TH ST N, STE. 109
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OH
Practice Address - Zip Code:74055
Practice Address - Country:US
Practice Address - Phone:918-609-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist