Individual
WANDA A BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
1131 N KICKAPOO AVE, SHAWNEE, OK 74801-4845
(405) 275-2877
(405) 275-2877
Mailing address
PO BOX 3, MORRIS, OK 74445-0003
(918) 733-9486
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC #3140
OK
Other
Enumeration date
11/09/2006
Last updated
02/09/2010
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