Provider Demographics
NPI:1558595207
Name:KEMP, JENNIFER NICHOLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICHOLE
Last Name:KEMP
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICHOLE
Other - Last Name:NUNNERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CFY-SLP
Mailing Address - Street 1:3 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-3319
Mailing Address - Country:US
Mailing Address - Phone:405-255-0642
Mailing Address - Fax:
Practice Address - Street 1:3 MAYFAIR DR
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-3319
Practice Address - Country:US
Practice Address - Phone:405-255-0642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3498235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist