Provider Demographics
NPI:1043749310
Name:ZUIDEMA, JAQ L (MSW)
Entity Type:Individual
Prefix:
First Name:JAQ
Middle Name:L
Last Name:ZUIDEMA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W KNOXVILLE ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5361
Mailing Address - Country:US
Mailing Address - Phone:918-927-4271
Mailing Address - Fax:
Practice Address - Street 1:2121 S 125TH EAST AVE STE 106
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-5800
Practice Address - Country:US
Practice Address - Phone:918-574-8442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator