Healthcare Provider Details

I. General information

NPI: 1417812017
Provider Name (Legal Business Name): BRIANA M HENDRICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N BROADWAY ST
CLEVELAND OK
74020-3421
US

IV. Provider business mailing address

415 W KIOWA AVE
CLEVELAND OK
74020-3415
US

V. Phone/Fax

Practice location:
  • Phone: 539-209-1209
  • Fax: 539-203-3672
Mailing address:
  • Phone: 539-209-1209
  • Fax: 539-203-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-500444
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: