Provider Demographics
NPI:1003383753
Name:RIDGE, DALANIE M
Entity Type:Individual
Prefix:
First Name:DALANIE
Middle Name:M
Last Name:RIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DALANIE
Other - Middle Name:M
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:MOORELAND
Mailing Address - State:OK
Mailing Address - Zip Code:73852-0053
Mailing Address - Country:US
Mailing Address - Phone:580-273-8691
Mailing Address - Fax:
Practice Address - Street 1:5050 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-7713
Practice Address - Country:US
Practice Address - Phone:580-256-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker