Provider Demographics
NPI:1093044489
Name:JACKSON-MORRIS, JULIE A (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:A
Last Name:JACKSON-MORRIS
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 HUGHES DR
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-5469
Mailing Address - Country:US
Mailing Address - Phone:918-931-9858
Mailing Address - Fax:
Practice Address - Street 1:408 HUGHES DR
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5469
Practice Address - Country:US
Practice Address - Phone:918-931-9858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2990235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2990OtherOBESPA