MEDICARE: KIMBERLY WADE M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	4431	OK

General Provider Information

NPI Number	:	1053771758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY WADE M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	7808 S URBANA AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-8111
Country	:	US
Telephone Number	:	918-441-8554
Fax Number	:

Provider Business Practice Location Address
First Line	:	6846 S CANTON AVE STE 120
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3412
Country	:	US
Telephone Number	:	918-441-8554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2016
Last Update Date	:	03/24/2026

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Directions to “ KIMBERLY WADE M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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