Individual
JESSICA RAE NGOTNGAMWONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
7935 E 57TH ST, TULSA, OK 74145
(918) 268-6379
Mailing address
6216 S LEWIS AVE, STE 180, TULSA, OK 74136-1077
(918) 960-7852
(539) 664-5738
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4891
OK
Other
Enumeration date
02/02/2009
Last updated
07/28/2021
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