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Individual

CODY MICHAEL WANN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
510 N BROADWAY ST, POTEAU, OK 74953-3536
(918) 647-4196
Mailing address
PO BOX 711, POTEAU, OK 74953-0711
(918) 647-4196

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPCCANDIDATE12760
OK

Other

Enumeration date
09/18/2023
Last updated
09/11/2025
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