Healthcare Provider Details

I. General information

NPI: 1255577334
Provider Name (Legal Business Name): MRS. SHERRI ANN CLONINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N 31ST ST
CLINTON OK
73601-9118
US

IV. Provider business mailing address

902 PRAIRIE VIEW ST
CLINTON OK
73601-9353
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-6021
  • Fax:
Mailing address:
  • Phone: 580-445-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: