Provider Demographics
NPI:1588944615
Name:RAYFIELD, JASON BENNELL
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:BENNELL
Last Name:RAYFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7221 EDENBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5614
Mailing Address - Country:US
Mailing Address - Phone:719-310-1906
Mailing Address - Fax:
Practice Address - Street 1:7221 EDENBOROUGH
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132
Practice Address - Country:US
Practice Address - Phone:719-310-1906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-20
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker