Individual
KALLY LANE RAINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
715 E SHAWNTEL SMITH BLVD, MULDROW, OK 74948-7494
(918) 427-7406
Mailing address
106393 S 4720 RD, MULDROW, OK 74948-7236
(479) 353-0513
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/25/2020
Last updated
09/08/2021
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