Individual
LISA ELLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1401 W PAWNEE ST, CLEVELAND, OK 74020-3033
(918) 358-2501
Mailing address
RR 2 BOX 435G, CLEVELAND, OK 74020-9671
(918) 358-5366
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1742
OK
Other
Enumeration date
06/29/2007
Last updated
07/08/2007
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