Healthcare Provider Details

I. General information

NPI: 1013282417
Provider Name (Legal Business Name): JENNIFER LEE PRIBBLE MSW, U/S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202639 E COUNTY ROAD 42
WOODWARD OK
73801-5442
US

IV. Provider business mailing address

202639 E COUNTY ROAD 42
WOODWARD OK
73801-5442
US

V. Phone/Fax

Practice location:
  • Phone: 580-254-5322
  • Fax: 580-254-5335
Mailing address:
  • Phone: 580-254-5322
  • Fax: 580-254-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: