Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 1736 | OK |
NPI | 1003166760 |
---|---|
Provider Name | Ms. Connie Lynn Schlittler |
First Address | Edmond, OK 73013-6854 |
Second Address | Edmond, OK 73013-6854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2012 |
Last Update Date | 10/09/2012 |