Individual
MS. JENNIFER NOELLE PETTIJOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
109 N FAIRLAND ST., PRYOR, OK 74361-4203
(918) 825-1405
(918) 825-1406
Mailing address
109 N FAIRLAND ST., PRYOR, OK 74361-4203
(918) 825-1405
(918) 825-1406
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6246
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200372200A
—
OK
Enumeration date
09/12/2011
Last updated
02/11/2022
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