Provider Demographics
NPI:1497177562
Name:RIDGWAY, JANNA JOELLE (MA, LPC NCC)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:JOELLE
Last Name:RIDGWAY
Suffix:
Gender:F
Credentials:MA, LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-3708
Mailing Address - Country:US
Mailing Address - Phone:580-364-0606
Mailing Address - Fax:
Practice Address - Street 1:563 W 13TH ST
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-3708
Practice Address - Country:US
Practice Address - Phone:580-364-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor