Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003117581 |
---|---|
Provider Name | Mrs. Kateri Suzanna Bohanan |
First Address | Oklahoma City, OK 73127-6339 |
Second Address | Oklahoma City, OK 73127-6339 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2010 |
Last Update Date | 24/06/2013 |