MEDICARE: MISS SANDRA WAGNER RYDEN MSW, LCSW,

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
1	1041C0700X	Clinical Social Worker	0674	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0007391110	OTHER		AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578569018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SANDRA WAGNER RYDEN MSW, LCSW,

Provider Business Mailing Address
First Line	:	PO BOX 5574
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73070-5574
Country	:	US
Telephone Number	:	405-360-7165
Fax Number	:	405-360-7165

Provider Business Practice Location Address
First Line	:	1818 W LINDSEY ST STE C212
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73069-4159
Country	:	US
Telephone Number	:	405-360-7165
Fax Number	:	405-360-7165

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	12/10/2015

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