Provider Demographics
NPI:1982444329
Name:LANDUA, JENNA (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:LANDUA
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 GOLDEN LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-4286
Mailing Address - Country:US
Mailing Address - Phone:619-261-8894
Mailing Address - Fax:
Practice Address - Street 1:307 E DANFORTH RD STE 130
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4485
Practice Address - Country:US
Practice Address - Phone:397-355-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist