Provider Demographics
NPI:1336468578
Name:KINCANON, JODI LYNN
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYNN
Last Name:KINCANON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 CHISHOLM TRL
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-2339
Mailing Address - Country:US
Mailing Address - Phone:580-302-3423
Mailing Address - Fax:580-774-5285
Practice Address - Street 1:1404 CHISHOLM TRL
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-2339
Practice Address - Country:US
Practice Address - Phone:580-302-3423
Practice Address - Fax:580-774-5285
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker