Healthcare Provider Details

I. General information

NPI: 1578942264
Provider Name (Legal Business Name): JENNIFER WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 SE 1060TH AVE
RED OAK OK
74563-2304
US

IV. Provider business mailing address

229 SE 1060TH AVE
RED OAK OK
74563-2304
US

V. Phone/Fax

Practice location:
  • Phone: 580-916-1650
  • Fax:
Mailing address:
  • Phone: 580-916-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3047
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: