Provider Demographics
NPI:1336423292
Name:RANDLEMAN, JENNIFER SUSETTE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUSETTE
Last Name:RANDLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RT. 1 BOX 131-C
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432
Mailing Address - Country:US
Mailing Address - Phone:918-441-0653
Mailing Address - Fax:918-452-3939
Practice Address - Street 1:RR 1 BOX 131C
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-9223
Practice Address - Country:US
Practice Address - Phone:918-441-0653
Practice Address - Fax:918-452-3939
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health