Provider Demographics
NPI:1649511494
Name:WANDEL, KATHLEEN J (BHCM, MPA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:WANDEL
Suffix:
Gender:F
Credentials:BHCM, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 ALAMEDA ST BLDG D
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-5229
Mailing Address - Country:US
Mailing Address - Phone:405-573-3998
Mailing Address - Fax:405-573-3939
Practice Address - Street 1:909 ALAMEDA ST BLDG D
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5229
Practice Address - Country:US
Practice Address - Phone:405-573-3998
Practice Address - Fax:405-573-3939
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker