Healthcare Provider Details

I. General information

NPI: 1750778817
Provider Name (Legal Business Name): ANGELA PENN-JUENGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N HIGHWAY 59 STE 2
KANSAS OK
74347-7076
US

IV. Provider business mailing address

2919 US HIGHWAY 412
ROSE OK
74364-1111
US

V. Phone/Fax

Practice location:
  • Phone: 405-806-7695
  • Fax:
Mailing address:
  • Phone: 405-806-7695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9032
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: