Provider Demographics
NPI:1134219421
Name:TEEL, JERRY R (PHD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:R
Last Name:TEEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 N PORTLAND AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2082
Mailing Address - Country:US
Mailing Address - Phone:405-659-2902
Mailing Address - Fax:
Practice Address - Street 1:5401 N PORTLAND AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2082
Practice Address - Country:US
Practice Address - Phone:405-659-2902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist