Individual
JENNIFER BANTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
909 BRONZE MEDAL RD, MOORE, OK 73160-7971
(405) 590-6397
(405) 271-3052
Mailing address
909 BRONZE MEDAL RD, MOORE, OK 73160-7971
(405) 590-6397
(405) 271-3052
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2587
OK
Other
Enumeration date
10/24/2022
Last updated
10/24/2022
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