Individual
MRS. JENNIE LOUISE ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
701 S. MAIN STREET, BROKEN ARROW, OK 74012
(918) 259-5700
Mailing address
701 S. MAIN STREET, BROKEN ARROW, OK 74012
(918) 259-5700
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4459
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200612430
—
OK
Enumeration date
08/10/2015
Last updated
03/19/2020
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