Individual
SONJA DEJACIMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
111 S MAIN ST, MCALESTER, OK 74501-5363
(918) 423-5204
Mailing address
2623 HARDY SPRINGS RD, MCALESTER, OK 74501-7390
(918) 424-5114
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
200305190B
OK
Other
Enumeration date
05/16/2012
Last updated
05/16/2012
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