1346282696 NPI number — MRS. STEPHANIE SUSANNE WATKINS MSW, LCSW

Table of content: MRS. STEPHANIE SUSANNE WATKINS MSW, LCSW (NPI 1346282696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346282696 NPI number — MRS. STEPHANIE SUSANNE WATKINS MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATKINS
Provider First Name:
STEPHANIE
Provider Middle Name:
SUSANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHALK
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
SUSANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346282696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14660 W 18TH ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAND SPRINGS
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74063-4405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-639-6887
Provider Business Mailing Address Fax Number:
918-241-2638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 N MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAND SPRINGS
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-514-4029
Provider Business Practice Location Address Fax Number:
918-419-2653
Provider Enumeration Date:
06/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  3902 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)