Provider Demographics
NPI:1962510768
Name:DODGE, JESSICA LYNELLE (BA)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LYNELLE
Last Name:DODGE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2609 FEATHERSTONE RD
Mailing Address - Street 2:APT 540
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2105
Mailing Address - Country:US
Mailing Address - Phone:405-819-8500
Mailing Address - Fax:
Practice Address - Street 1:1501 W. COMMERCE
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099
Practice Address - Country:US
Practice Address - Phone:405-354-1927
Practice Address - Fax:405-354-3927
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health