Individual
JENNA IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11410 S GRANITE AVE, TULSA, OK 74137-8111
(918) 629-5047
Mailing address
11410 S GRANITE AVE, TULSA, OK 74137-8111
(918) 629-5047
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
SLPA305
OK
Other
Enumeration date
12/30/2022
Last updated
12/30/2022
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