Healthcare Provider Details

I. General information

NPI: 1285479469
Provider Name (Legal Business Name): MALISA DAWN HEPNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WESTVIEW DR
YUKON OK
73099-6742
US

IV. Provider business mailing address

601 WESTVIEW DR
YUKON OK
73099-6742
US

V. Phone/Fax

Practice location:
  • Phone: 405-885-9523
  • Fax:
Mailing address:
  • Phone: 405-885-9523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number20044
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: