Provider Demographics
NPI:1265093314
Name:PRISCO-RUDOLPH, JAMIE R (MA)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:R
Last Name:PRISCO-RUDOLPH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14900 N PENNSYLVANIA AVE APT 1632
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-5912
Mailing Address - Country:US
Mailing Address - Phone:580-713-9353
Mailing Address - Fax:
Practice Address - Street 1:1251 N BROADWAY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3616
Practice Address - Country:US
Practice Address - Phone:405-341-3554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional