Healthcare Provider Details

I. General information

NPI: 1679760508
Provider Name (Legal Business Name): HEATHER SUE HORNBERGER BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 W 3RD ST
ELK CITY OK
73644-4323
US

IV. Provider business mailing address

2302 W COUNTRY CLUB BLVD APT A7
ELK CITY OK
73644-2272
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-5136
  • Fax: 580-323-0828
Mailing address:
  • Phone: 405-747-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: