Individual
LISA HARDAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17 S CENTRAL AVE, IDABEL, OK 74745-4625
(580) 353-9726
Mailing address
432057 STATE HIGHWAY 3, FORT TOWSON, OK 74735-7506
(580) 209-6179
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/22/2024
Last updated
04/21/2026
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