Individual
TAYLOR NICOLE WINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
904 NW 4TH ST, STIGLER, OK 74462-1653
(918) 967-8223
Mailing address
904 NW 4TH ST, STIGLER, OK 74462-1653
(918) 967-8223
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200507310
—
OK
Enumeration date
06/21/2019
Last updated
06/21/2019
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