MEDICARE: KRISTEN M. HADDAD

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

General Provider Information

NPI Number	:	1831425636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN M. HADDAD

Provider Business Mailing Address
First Line	:	1122 NE 13TH STREET
Second Line	:	ORI 274
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-1039
Country	:	US
Telephone Number	:	405-271-1515
Fax Number	:	405-271-6264

Provider Business Practice Location Address
First Line	:	711 STANTON L YOUNG BLVD STE 430
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5022
Country	:	US
Telephone Number	:	405-271-6434
Fax Number	:	405-271-6264

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

Provider Enumeration Date	:	10/29/2009
Last Update Date	:	05/18/2017

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