Provider Demographics
NPI:1689100026
Name:KRENCICKI, JESSICA ERIN (LMSW U/S)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN
Last Name:KRENCICKI
Suffix:
Gender:F
Credentials:LMSW U/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 N REDBUD DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-5121
Mailing Address - Country:US
Mailing Address - Phone:405-535-3593
Mailing Address - Fax:405-610-1693
Practice Address - Street 1:805 E ROBINSON ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071
Practice Address - Country:US
Practice Address - Phone:405-447-4499
Practice Address - Fax:405-447-4419
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5152104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker