Individual
JESSICA L LATHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP-CCC
Contact information
Practice address
2615 E RANDOLPH AVE, ENID, OK 73701-4670
(580) 234-3734
(580) 234-2615
Mailing address
1370 N INTERSTATE DR, STE 154, NORMAN, OK 73072-3377
(405) 307-6668
(405) 701-6170
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4442
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200598780A
—
OK
Enumeration date
07/27/2015
Last updated
07/20/2016
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