Shannon Deatherage, BSW

NPI #1629528302 in Ada, Oklahoma

Provider Information

NPI Number: 1629528302
Entity Type: Individual
Name: Shannon Deatherage, BSW
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Social Worker
Credential: BSW
Enumeration Date: Oct 6, 2016
Last Updated: Oct 6, 2016

Practice Location

Address: 3115 ARLINGTON ST
City: Ada
State: Oklahoma
ZIP Code: 74820-3085
Phone: (580) 332-6345

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker	104100000X	Primary

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