Provider Demographics
NPI:1437486669
Name:DENNIS, JERRI DAWN
Entity Type:Individual
Prefix:
First Name:JERRI
Middle Name:DAWN
Last Name:DENNIS
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 990
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:OK
Mailing Address - Zip Code:74536-0990
Mailing Address - Country:US
Mailing Address - Phone:918-373-1173
Mailing Address - Fax:
Practice Address - Street 1:608 HIGHWAY 271 N
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2055
Practice Address - Country:US
Practice Address - Phone:918-373-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health