Provider Demographics
NPI:1164964482
Name:RIEMER, JENINE F (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENINE
Middle Name:F
Last Name:RIEMER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 DIANA LANE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-9714
Mailing Address - Country:US
Mailing Address - Phone:405-510-5248
Mailing Address - Fax:405-366-0010
Practice Address - Street 1:1201 W. BOYD ST.
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4801
Practice Address - Country:US
Practice Address - Phone:405-366-7898
Practice Address - Fax:405-366-0010
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200675040AMedicaid