Healthcare Provider Details

I. General information

NPI: 1558378125
Provider Name (Legal Business Name): LINDY GRACE KROENERT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 W 11TH ST
TULSA OK
74127-9014
US

IV. Provider business mailing address

2345 SOUTHWEST BLVD
TULSA OK
74107-2705
US

V. Phone/Fax

Practice location:
  • Phone: 918-382-3100
  • Fax: 918-382-3188
Mailing address:
  • Phone: 918-382-3100
  • Fax: 918-382-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1969
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: