Provider Demographics
NPI:1891961439
Name:LUESADA, JARRED CURTIS (MS-CCCSLP)
Entity Type:Individual
Prefix:
First Name:JARRED
Middle Name:CURTIS
Last Name:LUESADA
Suffix:
Gender:M
Credentials:MS-CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5429 QUAIL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-3480
Mailing Address - Country:US
Mailing Address - Phone:405-990-5262
Mailing Address - Fax:405-387-3056
Practice Address - Street 1:5429 QUAIL RIDGE RD
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-3480
Practice Address - Country:US
Practice Address - Phone:405-990-5262
Practice Address - Fax:405-387-3056
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3197235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist