Individual
BROOKLYNN S LICASTRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
107 N MAIN ST, KINGFISHER, OK 73750-2730
(405) 776-0500
Mailing address
23597 192ND NW, GEARY, OK 73040-4306
(405) 697-6706
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/31/2025
Last updated
11/24/2025
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