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Individual

JENNIFER WADE STAFFORD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
202639 E COUNTY ROAD 42, WOODWARD, OK 73801-5442
(580) 254-5322
(580) 254-5335
Mailing address
512 AVENUE I, BEAVER, OK 73932-3303
(580) 651-0812

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
01/20/2012
Last updated
01/20/2012
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Product
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  • EDI platform