Healthcare Provider Details

I. General information

NPI: 1578714119
Provider Name (Legal Business Name): DEANNA GLENNETTE UKENA L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 S WALNUT ST
STILLWATER OK
74074-4222
US

IV. Provider business mailing address

604 S WALNUT ST
STILLWATER OK
74074-4222
US

V. Phone/Fax

Practice location:
  • Phone: 405-338-7072
  • Fax: 405-445-3780
Mailing address:
  • Phone: 405-338-7072
  • Fax: 405-445-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2850
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: