Provider Demographics
NPI:1265958508
Name:BURNETT, TORI (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TORI
Middle Name:
Last Name:BURNETT
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 1:501 MEADOW RUN CT
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-5758
Mailing Address - Country:US
Mailing Address - Phone:405-640-3123
Mailing Address - Fax:
Practice Address - Street 1:501 MEADOW RUN CT
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7309
Practice Address - Country:US
Practice Address - Phone:405-640-3123
Practice Address - Fax:405-640-3123
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3332235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist