Provider Demographics
NPI:1609582352
Name:SCHOENHALS, JAKE HANSEN
Entity Type:Individual
Prefix:MR
First Name:JAKE
Middle Name:HANSEN
Last Name:SCHOENHALS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 NW 63RD ST APT 412
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-4831
Mailing Address - Country:US
Mailing Address - Phone:405-246-6477
Mailing Address - Fax:
Practice Address - Street 1:13404 N MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8311
Practice Address - Country:US
Practice Address - Phone:405-752-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-16-23187103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst