Individual
SEMIAH MADISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
416 W 15TH ST STE 600, EDMOND, OK 73013-3672
(405) 562-6072
Mailing address
701 SAMMY DAVIS JR DR, LANGSTON, OK 73050-5002
(405) 562-6072
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
OK
Other
Enumeration date
03/09/2026
Last updated
03/09/2026
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