Healthcare Provider Details

I. General information

NPI: 1730764374
Provider Name (Legal Business Name): FUNCTIONAL FOUNDATIONS SPEECH THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/29/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 W PITTSBURG ST
BROKEN ARROW OK
74012-4731
US

IV. Provider business mailing address

2312 W PITTSBURG ST
BROKEN ARROW OK
74012-4731
US

V. Phone/Fax

Practice location:
  • Phone: 918-808-1380
  • Fax:
Mailing address:
  • Phone: 918-808-1380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE CALIBEY
Title or Position: OWNER
Credential: MS, CCC-SLP
Phone: 918-808-1380