Healthcare Provider Details

I. General information

NPI: 1255480505
Provider Name (Legal Business Name): JENNIFER JEAN LADD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 N FLOOD AVE
NORMAN OK
73069
US

IV. Provider business mailing address

8809 ALAMEDA DR
NORMAN OK
73026-3549
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-3719
  • Fax: 405-364-3209
Mailing address:
  • Phone: 405-343-4244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2591
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: