Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
Y | 1041C0700X | Clinical Social Worker | 6571 | OK |
NPI | 1003220906 |
---|---|
Provider Name | Katherine Shook |
First Address | Jay, OK 74346-2201 |
Second Address | Jay, OK 74346-2201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2014 |
Last Update Date | 24/10/2018 |