Jordan M Mack
Individual provider Active NPI Rehabilitation Psychologist · Soper, OK
NPI 1356589873 · NPPES record last updated Mar 31, 2009
Key facts
- NPI
- 1356589873
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Rehabilitation Psychologist 103TR0400X
- Practice address
- RR 1 Box 131
Soper, OK 74759-9632 - Phone
- (580) 317-5209
- NPI assigned
- Jan 22, 2009
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Psychologist | 103TR0400X | Yes |
Addresses
Primary practice location
RR 1 Box 131
Soper, OK 74759-9632
Mailing address
RR 1 Box 131
Soper, OK 74759-9632
Phone (580) 317-5209
Other providers in Soper, OK
All providers in Soper, OK · Rehabilitation Psychologist in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.