Provider Demographics
NPI:1114813565
Name:POLK, JADA MAE (RBT-25-444727)
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:MAE
Last Name:POLK
Suffix:
Gender:F
Credentials:RBT-25-444727
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:73057-9598
Mailing Address - Country:US
Mailing Address - Phone:405-803-4451
Mailing Address - Fax:
Practice Address - Street 1:930 WALL ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6319
Practice Address - Country:US
Practice Address - Phone:405-384-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-25-444727106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician