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NPI Code Detail

MEDICARE: JERRI DAWN DENNIS

MEDICARE: JERRI DAWN DENNIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1437486669
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRI DAWN DENNIS
Provider Business Mailing Address
First Line : PO BOX 990
Second Line :
City : CLAYTON
State : OK
Zip : 74536-0990
Country : US
Telephone Number : 918-373-1173
Fax Number :
Provider Business Practice Location Address
First Line : 608 HIGHWAY 271 N
Second Line :
City : ANTLERS
State : OK
Zip : 74523-2055
Country : US
Telephone Number : 918-373-1173
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2009
Last Update Date : 11/09/2009

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Directions to “ JERRI DAWN DENNIS ” Practice Location

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