Provider Demographics
NPI:1720755721
Name:KAISER, CALLIE MARIAH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:MARIAH
Last Name:KAISER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:CALLIE
Other - Middle Name:MARIAH
Other - Last Name:GOAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-3812
Mailing Address - Country:US
Mailing Address - Phone:918-473-5619
Mailing Address - Fax:
Practice Address - Street 1:205 OWENS AVE
Practice Address - Street 2:
Practice Address - City:CHECOTAH
Practice Address - State:OK
Practice Address - Zip Code:74426-5255
Practice Address - Country:US
Practice Address - Phone:918-473-5832
Practice Address - Fax:918-473-6654
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKSP5628235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist