Provider Demographics
NPI:1811641483
Name:HODGE, JANA M (CMII, BHRS, WC)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:M
Last Name:HODGE
Suffix:
Gender:
Credentials:CMII, BHRS, WC
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:MARIE
Other - Last Name:HASLIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:502 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OK
Mailing Address - Zip Code:73077-5022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:502 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-5022
Practice Address - Country:US
Practice Address - Phone:918-308-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator