Provider Demographics
NPI:1134536915
Name:ROUSE, PATRICIA S
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:ROUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SOUTH MAIN STRETT
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:OK
Mailing Address - Zip Code:73651
Mailing Address - Country:US
Mailing Address - Phone:580-726-2452
Mailing Address - Fax:580-726-2483
Practice Address - Street 1:216 SOUTH MAIN STRETT
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:OK
Practice Address - Zip Code:73651
Practice Address - Country:US
Practice Address - Phone:580-726-2452
Practice Address - Fax:580-726-2483
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker