Provider Demographics
NPI:1821213570
Name:HAYNES, JENNIFER E (MED)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19350 CARRIAGE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNDS
Mailing Address - State:OK
Mailing Address - Zip Code:74047-4767
Mailing Address - Country:US
Mailing Address - Phone:918-724-9318
Mailing Address - Fax:
Practice Address - Street 1:19350 CARRIAGE CT
Practice Address - Street 2:
Practice Address - City:MOUNDS
Practice Address - State:OK
Practice Address - Zip Code:74047-4767
Practice Address - Country:US
Practice Address - Phone:918-366-2693
Practice Address - Fax:918-366-2684
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist