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General NPI Number Information
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NPI Number | 1235788050
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Entity Type | Individual
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Provider Name | ROSE MARY PONDER
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Gender | Female
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 09/05/2019
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Provider Practice Location Address
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Address Line | 4045 NW 64TH ST STE 520
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-8608
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Country | US
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Telephone | 405-842-4911
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Fax | 405-842-5807
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Provider Business Mailing Address
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Address Line | 2019 N WOODS ST
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City | SHERMAN
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State | TX
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Zip | 75092-2753
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Country | US
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Telephone | 903-819-5851
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 4970
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License Number State | OK
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