Provider Demographics
NPI:1689858516
Name:MERRELL, JENNIFER RENAE (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RENAE
Last Name:MERRELL
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:OK
Mailing Address - Zip Code:73030-2723
Mailing Address - Country:US
Mailing Address - Phone:580-369-8377
Mailing Address - Fax:
Practice Address - Street 1:206 CEDAR DR
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:OK
Practice Address - Zip Code:73030-2723
Practice Address - Country:US
Practice Address - Phone:580-369-8377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist