Pettijohn, Jennifer Noelle
Pettijohn, Jennifer Noelle is an individual health care provider with primary practice located at 109 N Fairland St. , Pryor OK 74361-4203. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Pettijohn, Jennifer Noelle can be contacted via phone (918) 825-1405.Contact Information
Primary practice address
109 N Fairland St.
Pryor OK 74361-4203
Phone: (918) 825-1405
Fax: (918) 825-1406
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 6246 | Oklahoma |
Profile Details
| NPI number | 1295017614 |
|---|---|
| LBN Legal business name | Pettijohn, Jennifer Noelle |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 12th, 2011 |
| Last updated | Feb 11th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1295017614 | NPPES |
| Oklahoma | MEDICAID | 200372200A |
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