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General NPI Number Information
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NPI Number | 1265093314
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Entity Type | Individual
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Provider Name | JAMIE R PRISCO-RUDOLPH MA
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Gender | Female
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Dates
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Enumeration Date | 06/27/2019
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 1251 N BROADWAY
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City | EDMOND
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State | OK
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Zip | 73034-3616
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Country | US
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Telephone | 405-341-3554
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Fax |
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Provider Business Mailing Address
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Address Line | 14900 N PENNSYLVANIA AVE APT 1632
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-5912
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Country | US
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Telephone | 580-713-9353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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