Provider Demographics
NPI:1235967779
Name:STINSON, KADIE MICHELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KADIE
Middle Name:MICHELLE
Last Name:STINSON
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 1:27812 E 114TH PL S
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-6693
Mailing Address - Country:US
Mailing Address - Phone:580-319-2284
Mailing Address - Fax:
Practice Address - Street 1:27812 E 114TH PL S
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-6693
Practice Address - Country:US
Practice Address - Phone:580-319-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6040235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist