Basic Information
| Provider Information | |||||||||
| NPI: | 1952924490 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WACKLER | ||||||||
| FirstName: | KAMREE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4334 NW EXPRESSWAY STE 187 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731161515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055485167 | ||||||||
| FaxNumber: | 4052124270 | ||||||||
| Practice Location | |||||||||
| Address1: | 2401 NW 23RD ST STE 2D | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731072420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053553239 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2020 | ||||||||
| LastUpdateDate: | 05/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.