Provider Demographics
NPI:1912089640
Name:KLUCK, JANA BENGE (MA)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:BENGE
Last Name:KLUCK
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 1:8113 NW 128TH PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2212
Mailing Address - Country:US
Mailing Address - Phone:405-722-7021
Mailing Address - Fax:
Practice Address - Street 1:5622 N PORTLAND AVE STE 250
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2095
Practice Address - Country:US
Practice Address - Phone:405-722-7021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK393235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist