Provider Demographics
NPI:1558000596
Name:PEOPLES, JACI
Entity Type:Individual
Prefix:
First Name:JACI
Middle Name:
Last Name:PEOPLES
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 371
Mailing Address - Street 2:
Mailing Address - City:MANNSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:73447-0371
Mailing Address - Country:US
Mailing Address - Phone:580-371-1046
Mailing Address - Fax:
Practice Address - Street 1:2015 W BROADWAY ST STE 2C
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2560
Practice Address - Country:US
Practice Address - Phone:580-448-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-28
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCF439235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist