Healthcare Provider Details

I. General information

NPI: 1538754676
Provider Name (Legal Business Name): KRISTIN JEANELLE MCGUIRE SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SE 2ND ST
BLANCHARD OK
73010-5529
US

IV. Provider business mailing address

400 SE 2ND ST
BLANCHARD OK
73010-5529
US

V. Phone/Fax

Practice location:
  • Phone: 405-779-3270
  • Fax: 405-212-4705
Mailing address:
  • Phone: 405-779-3270
  • Fax: 405-212-4705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA112
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: