Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003383753 |
---|---|
Provider Name | Dalanie M Ridge |
First Address | Mooreland, OK 73852-0053 |
Second Address | Woodward, OK 73801-7713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2018 |
Last Update Date | 31/10/2018 |