Provider Demographics
NPI:1629189972
Name:NEEDHAM, JANETT DENISE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JANETT
Middle Name:DENISE
Last Name:NEEDHAM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
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 3333
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-3333
Mailing Address - Country:US
Mailing Address - Phone:918-397-1993
Mailing Address - Fax:918-331-0002
Practice Address - Street 1:4017 PRICE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-7248
Practice Address - Country:US
Practice Address - Phone:918-397-1993
Practice Address - Fax:918-331-0002
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200083180AMedicaid