Provider Demographics
NPI:1407633316
Name:ESTEP, JACINDA CAITLIN
Entity Type:Individual
Prefix:
First Name:JACINDA
Middle Name:CAITLIN
Last Name:ESTEP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538-0817
Mailing Address - Country:US
Mailing Address - Phone:580-454-9200
Mailing Address - Fax:580-454-9205
Practice Address - Street 1:9201 STATE HIGHWAY 17 STE F
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:OK
Practice Address - Zip Code:73538-4517
Practice Address - Country:US
Practice Address - Phone:580-454-9200
Practice Address - Fax:580-454-9205
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKSLPA2932355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty