Provider Demographics
NPI:1629505946
Name:OAKLEY, JENNIFER LEE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:OAKLEY
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 1:3510 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2357
Mailing Address - Country:US
Mailing Address - Phone:740-935-4083
Mailing Address - Fax:
Practice Address - Street 1:1170 TILE MILL RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:OH
Practice Address - Zip Code:45613-9435
Practice Address - Country:US
Practice Address - Phone:740-226-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP6489235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist