MEDICARE: MRS. KELLI JANE SONDAG M.A.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1720093206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLI JANE SONDAG M.A.

Provider Business Mailing Address
First Line	:	2404 W OCALA ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74011-4527
Country	:	US
Telephone Number	:	918-451-5738
Fax Number	:

Provider Business Practice Location Address
First Line	:	2325 S HARVARD AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74114-3300
Country	:	US
Telephone Number	:	918-744-4805
Fax Number	:

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	08/28/2007

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