Provider Demographics
NPI:1215815378
Name:SLACKTER, KRISTIEN
Entity type:Individual
Prefix:
First Name:KRISTIEN
Middle Name:
Last Name:SLACKTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3026 E 8TH ST APT 4621
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-7440
Mailing Address - Country:US
Mailing Address - Phone:818-644-2581
Mailing Address - Fax:
Practice Address - Street 1:3026 E 8TH ST APT 4621
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-7440
Practice Address - Country:US
Practice Address - Phone:818-644-2581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer