Individual
LESLIE MARIE DAWALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7935 E 57TH ST, TULSA, OK 74145-8622
(918) 358-6877
Mailing address
7935 E 57TH ST, TULSA, OK 74145-8622
(918) 358-6877
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
4204
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200372900A
—
OK
Enumeration date
08/22/2007
Last updated
12/11/2018
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