Healthcare Provider Details

I. General information

NPI: 1114469079
Provider Name (Legal Business Name): LAURA DRYDEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 09/08/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8925 OK HWY 66
SAPULPA OK
74131-0001
US

IV. Provider business mailing address

8925 OK HWY 66
SAPULPA OK
74131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 918-347-2003
  • Fax: 918-347-2005
Mailing address:
  • Phone: 918-347-2003
  • Fax: 918-347-2005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22782-P
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: