Provider Demographics
NPI:1215640198
Name:BURLING, MARY KATELYN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATELYN
Last Name:BURLING
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATELYN
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:2620 E 14TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4708
Mailing Address - Country:US
Mailing Address - Phone:405-517-5011
Mailing Address - Fax:
Practice Address - Street 1:1911 W C ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2367
Practice Address - Country:US
Practice Address - Phone:918-409-0157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist