Individual
MICHELE RAE DIESSELHORST-REESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
16608 VENTANA BLVD, EDMOND, OK 73003-8986
(405) 340-3753
Mailing address
16608 VENTANA BLVD, EDMOND, OK 73003-8986
(405) 340-3753
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3024
OK
Other
Enumeration date
09/02/2006
Last updated
07/08/2007
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