Individual
ELLEN MARIE REISWIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2325 S HARVARD AVE, TULSA, OK 74114-3300
(918) 712-4301
(918) 560-1399
Mailing address
650 S PEORIA AVE, TULSA, OK 74120-4429
(918) 587-9471
(918) 560-1399
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5EMR79
ICIS
OK
Enumeration date
05/06/2011
Last updated
03/17/2018
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