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NPI Code Detail

MEDICARE: MISS SANDE NICKEISHA SWABY LADC INTENT

MEDICARE: MISS SANDE NICKEISHA SWABY LADC INTENT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorOK

General Provider Information

NPI Number : 1326179599
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS SANDE NICKEISHA SWABY LADC INTENT
Provider Business Mailing Address
First Line : 229 CHALMETTE DR APT B
Second Line :
City : NORMAN
State : OK
Zip : 73071-2880
Country : US
Telephone Number : 405-524-1076
Fax Number :
Provider Business Practice Location Address
First Line : 2701 N OKLAHOMA AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73105-2724
Country : US
Telephone Number : 405-552-8868
Fax Number : 405-528-8692
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 07/09/2007

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Directions to “ MISS SANDE NICKEISHA SWABY LADC INTENT” Practice Location

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