Provider Demographics
NPI:1063837516
Name:OIGBOKIE, KATHERIN
Entity type:Individual
Prefix:
First Name:KATHERIN
Middle Name:
Last Name:OIGBOKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERIN
Other - Middle Name:
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:20658 STONE OAK PKWY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7361
Mailing Address - Country:US
Mailing Address - Phone:210-876-5282
Mailing Address - Fax:210-864-2199
Practice Address - Street 1:20658 STONE OAK PKWY UNIT 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7361
Practice Address - Country:US
Practice Address - Phone:210-876-5282
Practice Address - Fax:210-864-2199
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109757235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4310906Medicaid