MEDICARE: JENNIFER LAUREN HALE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1348	OK

General Provider Information

NPI Number	:	1609465491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LAUREN HALE PH.D.

Provider Business Mailing Address
First Line	:	3013 E 101ST PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-5628
Country	:	US
Telephone Number	:	940-597-1840
Fax Number	:

Provider Business Practice Location Address
First Line	:	5310 E 31ST ST
Second Line	:	WEST TOWER
City	:	TULSA
State	:	OK
Zip	:	74135-5018
Country	:	US
Telephone Number	:	940-597-1840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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