Provider Demographics
NPI:1154983146
Name:ROBERTS, JADA NICOLE (MS, CGC)
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:NICOLE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:JADA
Other - Middle Name:NICOLE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:1205 NW 138TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1649
Mailing Address - Country:US
Mailing Address - Phone:405-821-1381
Mailing Address - Fax:
Practice Address - Street 1:1200 CHILDRENS AVE STE 12100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-8001
Practice Address - Fax:405-271-8697
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0339170300000X
170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS