Healthcare Provider Details

I. General information

NPI: 1295019370
Provider Name (Legal Business Name): MRS. JESSICA JOYCE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 NW 36TH ST SUITE 200
OKLAHOMA CITY OK
73112-2970
US

IV. Provider business mailing address

4408 N REDMOND AVE
BETHANY OK
73008-2845
US

V. Phone/Fax

Practice location:
  • Phone: 405-248-7105
  • Fax:
Mailing address:
  • Phone: 405-248-7105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: