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Individual

JANNA GREATHOUSE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS CCC SLP

Contact information

Practice address
11108 S 2ND ST, JENKS, OK 74037-2061
(918) 504-4895
Mailing address
11108 S 2ND ST, JENKS, OK 74037-2061
(918) 504-4895

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3302
OK
235Z00000X
Speech-Language Pathologist
3304
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
SA0596
SC
Enumeration date
08/30/2006
Last updated
02/19/2008
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