Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6403 | OK |
NPI | 1003408618 |
---|---|
Provider Name | Megan Rachelle Wadsack |
First Address | Oklahoma City, OK 73157-2978 |
Second Address | Oklahoma City, OK 73107-6437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2021 |
Last Update Date | 04/02/2021 |