Healthcare Provider Details

I. General information

NPI: 1285299008
Provider Name (Legal Business Name): CATHERINE SHANON MADDAN LMSW-P U/S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N HIGHWAY 59
KANSAS OK
74347
US

IV. Provider business mailing address

282 STATE HIGHWAY 10
KANSAS OK
74347-1640
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-4434
  • Fax: 918-786-4435
Mailing address:
  • Phone: 918-509-3528
  • Fax: 918-525-0013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number21492-P
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: