Provider Demographics
NPI:1255770574
Name:FAIRSHEETS, WHITNEY KAELIN (MSCCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:KAELIN
Last Name:FAIRSHEETS
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 NW 186TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-7663
Mailing Address - Country:US
Mailing Address - Phone:405-509-4168
Mailing Address - Fax:
Practice Address - Street 1:4101 NW 122ND ST STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8816
Practice Address - Country:US
Practice Address - Phone:405-562-9260
Practice Address - Fax:405-260-9559
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3859235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist