Provider Demographics
NPI:1457958175
Name:KIRKPATRICK, SHAYE LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHAYE
Middle Name:LYNN
Last Name:KIRKPATRICK
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 1:11912 S NANDINA ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4375
Mailing Address - Country:US
Mailing Address - Phone:918-852-6348
Mailing Address - Fax:
Practice Address - Street 1:11912 S NANDINA ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-4375
Practice Address - Country:US
Practice Address - Phone:918-852-6348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4719235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherN/A