Healthcare Provider Details

I. General information

NPI: 1467919258
Provider Name (Legal Business Name): SUZANNE ALAIN WATERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10344 GREENBRIAR PKWY
OKLAHOMA CITY OK
73159-7643
US

IV. Provider business mailing address

12312 S LAND AVE
OKLAHOMA CITY OK
73170-4514
US

V. Phone/Fax

Practice location:
  • Phone: 405-252-0515
  • Fax: 405-698-2776
Mailing address:
  • Phone: 405-252-0515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20042
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: