Provider Demographics
NPI:1548055791
Name:HARTIN, KATI SHAYNE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATI
Middle Name:SHAYNE
Last Name:HARTIN
Suffix:
Gender:
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 1:12456 S 66TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-2635
Mailing Address - Country:US
Mailing Address - Phone:918-774-7039
Mailing Address - Fax:
Practice Address - Street 1:6941 E 121ST ST S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2317
Practice Address - Country:US
Practice Address - Phone:918-774-7039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5304235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty