Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1053747196 |
---|---|
Provider Name | Wendi Poulson |
First Address | Sulphur, OK 73086-1001 |
Second Address | Ardmore, OK 73401-2280 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2013 |
Last Update Date | 20/09/2013 |