Provider Demographics
NPI:1114206745
Name:PARKER, JEANA KIM (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JEANA
Middle Name:KIM
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14865 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8640
Mailing Address - Country:US
Mailing Address - Phone:405-210-7034
Mailing Address - Fax:405-883-6342
Practice Address - Street 1:14865 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8640
Practice Address - Country:US
Practice Address - Phone:405-210-7034
Practice Address - Fax:405-883-6342
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-13
Last Update Date:2011-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2866235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist