Healthcare Provider Details

I. General information

NPI: 1689139123
Provider Name (Legal Business Name): JEFFREY DALTON REED B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S MAIN ST
HOBART OK
73651-3628
US

IV. Provider business mailing address

8309 N. 2280 RD
CUSTER CITY OK
73639
US

V. Phone/Fax

Practice location:
  • Phone: 580-726-2452
  • Fax:
Mailing address:
  • Phone: 405-306-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21421
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: