Provider Demographics
NPI:1285137216
Name:BRANDON, JEANNE LEE (BS)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:LEE
Last Name:BRANDON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:LEE
Other - Last Name:BRANDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:111 SEQUOYAH LN
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-1756
Mailing Address - Country:US
Mailing Address - Phone:580-482-2809
Mailing Address - Fax:580-482-2820
Practice Address - Street 1:111 SEQUOYAH LN
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-1756
Practice Address - Country:US
Practice Address - Phone:580-482-2809
Practice Address - Fax:580-482-2820
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker