Provider Demographics
NPI:1376756593
Name:CRABB, JENNIFER JOLENE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOLENE
Last Name:CRABB
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9008 S NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-3036
Mailing Address - Country:US
Mailing Address - Phone:918-488-0035
Mailing Address - Fax:
Practice Address - Street 1:3000 S ELM PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7917
Practice Address - Country:US
Practice Address - Phone:918-455-3535
Practice Address - Fax:918-451-5287
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist