Individual
LAUREN PENSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 KIOWA ST, ARDMORE, OK 73401-2280
(580) 670-3117
Mailing address
1301 KIOWA ST, ARDMORE, OK 73401-2280
(580) 670-3117
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
L083851156
OK
Other
Enumeration date
02/10/2020
Last updated
02/01/2022
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