Provider Demographics
NPI:1407978877
Name:JESSUP, PERMA SUE (MS)
Entity Type:Individual
Prefix:MRS
First Name:PERMA
Middle Name:SUE
Last Name:JESSUP
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-8729
Mailing Address - Country:US
Mailing Address - Phone:405-373-9205
Mailing Address - Fax:
Practice Address - Street 1:9220 FALCON DR
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-8729
Practice Address - Country:US
Practice Address - Phone:405-373-9205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK233237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter