Jackie Ellen Chuculate

NPI #1063903029 in Vinita, Oklahoma

Provider Information

NPI Number: 1063903029
Entity Type: Individual
Name: Jackie Ellen Chuculate
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Peer Specialist
Enumeration Date: May 25, 2018
Last Updated: Jun 16, 2018

Practice Location

Address: 405 E EXCELSIOR AVE
City: Vinita
State: Oklahoma
ZIP Code: 74301-4226
Phone: (918) 256-6474

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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