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General NPI Number Information
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NPI Number | 1366352973
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Entity Type | Individual
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Provider Name | JASMINE MICHELLE STIDMAN C-SLPA
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Gender | Female
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Dates
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Enumeration Date | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 123 E 6TH ST
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City | OKMULGEE
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State | OK
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Zip | 74447-4603
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Country | US
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Telephone | 918-938-0887
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Fax |
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Provider Business Mailing Address
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Address Line | 706 S MIAMI AVE
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City | OKMULGEE
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State | OK
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Zip | 74447-6339
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Country | US
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Telephone | 918-520-1459
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State | OK
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