Provider Demographics
NPI:1437422706
Name:WOOLETT, JENNIFER BLONDELL (LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BLONDELL
Last Name:WOOLETT
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:BLONDELL
Other - Middle Name:
Other - Last Name:WOOLETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:711 S MUSKOGEE AVE
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-4717
Mailing Address - Country:US
Mailing Address - Phone:918-207-0078
Mailing Address - Fax:918-207-0558
Practice Address - Street 1:227 N WATER AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-2825
Practice Address - Country:US
Practice Address - Phone:918-207-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst