Individual
JENNIFER RENEE POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
14453 SE 29TH ST, SUITE D, CHOCTAW, OK 73020-6541
(405) 741-2844
Mailing address
1025 RENITA CT, MOORE, OK 73160-8702
(405) 837-5841
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1101
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200226900A
—
OK
Enumeration date
08/08/2008
Last updated
08/11/2011
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