Healthcare Provider Details

I. General information

NPI: 1124250550
Provider Name (Legal Business Name): JENNIFER D OHLSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 HAYES ST
WICHITA FALLS TX
76309-2136
US

IV. Provider business mailing address

1412 HAYES ST
WICHITA FALLS TX
76309-2136
US

V. Phone/Fax

Practice location:
  • Phone: 940-720-0797
  • Fax: 801-749-2545
Mailing address:
  • Phone: 940-720-0797
  • Fax: 801-749-2545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number105019
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: