Provider Demographics
NPI:1508757006
Name:UTENDAHL, ANIYAH
Entity type:Individual
Prefix:
First Name:ANIYAH
Middle Name:
Last Name:UTENDAHL
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 1:14600 N ROCKWELL AVE APT 2013
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-8221
Mailing Address - Country:US
Mailing Address - Phone:405-471-1704
Mailing Address - Fax:
Practice Address - Street 1:306 W COVELL RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-2113
Practice Address - Country:US
Practice Address - Phone:405-359-6651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-12
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty