Individual
SHANNON DEATHERAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW
Contact information
Practice address
3115 ARLINGTON ST, ADA, OK 74820-3085
(580) 332-6345
(580) 421-7724
Mailing address
2119 HAWK CIR, ADA, OK 74820-6001
(580) 332-6345
(580) 421-7724
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
10/06/2016
Last updated
10/06/2016
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