Individual
JESSICA PENDERGRAFT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 W CHEROKEE AVE STE 102, ENID, OK 73701-5600
(580) 340-7235
Mailing address
615 AMY DR, WAUKOMIS, OK 73773-1033
(580) 478-5035
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6723
OK
Other
Enumeration date
08/22/2014
Last updated
11/02/2023
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