Individual
JACQUELINE BONTRAGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4444 E 31ST ST, TULSA, OK 74135-2131
(918) 340-0267
Mailing address
4444 E 31ST ST, TULSA, OK 74135-2131
(918) 340-0267
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100746170G
—
OK
Enumeration date
02/25/2014
Last updated
09/04/2025
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