Provider Demographics
NPI:1205135654
Name:PEARSON, JANA (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JANA
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 BOBCAT TRL
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-0274
Mailing Address - Country:US
Mailing Address - Phone:405-819-2983
Mailing Address - Fax:
Practice Address - Street 1:736 BOBCAT TRL
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-0274
Practice Address - Country:US
Practice Address - Phone:405-819-2983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3722235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist