Healthcare Provider Details

I. General information

NPI: 1932304037
Provider Name (Legal Business Name): MRS. SUSAN HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 W 7TH AVE
STILLWATER OK
74074-1911
US

IV. Provider business mailing address

4436 NW 50TH ST
OKLAHOMA CITY OK
73112-2212
US

V. Phone/Fax

Practice location:
  • Phone: 405-714-4151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21410
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: