Individual
JESSICA LARUN GROFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
12899 E 76TH ST N, STE. 109, OWASSO, OK 74055-4021
(918) 609-6003
(918) 609-6002
Mailing address
12899 E 76TH ST N, STE. 109, OWASSO, OK 74055-4021
(918) 609-6003
(918) 609-6002
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3861
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200425950A
—
OK
Enumeration date
04/23/2012
Last updated
11/08/2016
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