Individual
PAMELA SUE JENNINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
109 S HARRILL AVE, WAGONER, OK 74467-5317
(918) 485-3554
Mailing address
109 S HARRILL AVE, WAGONER, OK 74467-5317
(918) 485-3554
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/17/2011
Last updated
11/17/2011
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