1295178929 NPI number — MRS. JOCELYN JANEA HUMPHREY M.S. CCC-SLP

Table of content: RESLYN LASSEGUE (NPI 1659844033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295178929 NPI number — MRS. JOCELYN JANEA HUMPHREY M.S. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUMPHREY
Provider First Name:
JOCELYN
Provider Middle Name:
JANEA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROUNDS
Provider Other First Name:
JOCELYN
Provider Other Middle Name:
JANEA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S. CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295178929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11803 W COOKSEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESCENT
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73028-8774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-757-5851
Provider Business Mailing Address Fax Number:
405-260-8820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11803 W COOKSEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESCENT
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73028-8774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-757-5851
Provider Business Practice Location Address Fax Number:
405-260-8820
Provider Enumeration Date:
04/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  4180 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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