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General NPI Number Information
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NPI Number | 1487223855
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Entity Type | Individual
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Provider Name | KATIE MICHELE WIEDEMANN
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Gender | Female
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Dates
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Enumeration Date | 06/21/2021
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 1824 COMMONS CIR STE B
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City | YUKON
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State | OK
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Zip | 73099-9538
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Country | US
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Telephone | 405-467-6782
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Fax |
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Provider Business Mailing Address
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Address Line | 2416 NW 196TH TER
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City | EDMOND
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State | OK
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Zip | 73012-3631
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Country | US
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Telephone | 405-476-8284
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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