Provider Demographics
NPI:1013607043
Name:WITTROCK, JAMIE DAWN (MS CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:DAWN
Last Name:WITTROCK
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:DAWN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1436 E 37TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3212
Mailing Address - Country:US
Mailing Address - Phone:918-859-9550
Mailing Address - Fax:
Practice Address - Street 1:6161 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1992
Practice Address - Country:US
Practice Address - Phone:918-494-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCF457235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist