Individual
MRS. EDITH MARIA LEERDAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1217 W KNOXVILLE ST, BROKEN ARROW, OK 74012-8434
(918) 258-1857
(918) 258-6987
Mailing address
1217 W KNOXVILLE ST, BROKEN ARROW, OK 74012-8434
(918) 258-1857
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
OK
Other
Enumeration date
11/18/2011
Last updated
11/18/2011
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