Individual
WANDA W PRIDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
301 N 2ND ST, FAIRFAX, OK 74637-2012
(918) 642-3515
(918) 642-3519
Mailing address
212 N MAIN ST, FAIRFAX, OK 74637-3023
(918) 642-3100
(918) 642-5639
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3383
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3383
STATE LICENSE
OK
Enumeration date
02/27/2008
Last updated
06/02/2008
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