Provider Demographics
NPI:1881851681
Name:EDMONDS, KAYSI DON (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYSI
Middle Name:DON
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 TAFT DR # C
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-6740
Mailing Address - Country:US
Mailing Address - Phone:405-222-4671
Mailing Address - Fax:
Practice Address - Street 1:110 TAFT DR
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-6740
Practice Address - Country:US
Practice Address - Phone:405-816-0192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist