Provider Demographics
NPI:1740568047
Name:WILLIAMS, JENNIFER JUNE (MED,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JUNE
Last Name:WILLIAMS
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 1:10325 PAISLEY RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7859
Mailing Address - Country:US
Mailing Address - Phone:405-414-8427
Mailing Address - Fax:
Practice Address - Street 1:12201 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-8022
Practice Address - Country:US
Practice Address - Phone:405-752-5112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2122235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist