Individual
MISS SANDRA WAGNER RYDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW,
Contact information
Practice address
1818 W LINDSEY ST STE C212, NORMAN, OK 73069-4159
(405) 360-7165
(405) 360-7165
Mailing address
PO BOX 5574, NORMAN, OK 73070-5574
(405) 360-7165
(405) 360-7165
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0674
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007391110
AETNA
—
05
—
100707540A
—
OK
Enumeration date
06/21/2005
Last updated
12/10/2015
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