Provider Demographics
NPI:1639469562
Name:CLANTON, JENNIFER L
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:L
Last Name:CLANTON
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 1:1428 N NORMAN AVE
Mailing Address - Street 2:APT. 4
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-1718
Mailing Address - Country:US
Mailing Address - Phone:405-602-9410
Mailing Address - Fax:
Practice Address - Street 1:1428 N NORMAN AVE
Practice Address - Street 2:APT. 4
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-1718
Practice Address - Country:US
Practice Address - Phone:405-602-9410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health