Provider Demographics
NPI:1710267356
Name:NOBLE, JACKI LYNN (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JACKI
Middle Name:LYNN
Last Name:NOBLE
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17416 S 91ST EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-6415
Mailing Address - Country:US
Mailing Address - Phone:918-706-0989
Mailing Address - Fax:
Practice Address - Street 1:17416 S 91ST EAST AVE
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-6415
Practice Address - Country:US
Practice Address - Phone:918-706-0989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist