Provider Demographics
NPI:1053454223
Name:VANDERHOOF FOGLE, MANDY CATRINA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MANDY
Middle Name:CATRINA
Last Name:VANDERHOOF FOGLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:MANDY
Other - Middle Name:C
Other - Last Name:VANDERHOOF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:650 S PEORIA
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4429
Mailing Address - Country:US
Mailing Address - Phone:918-587-9471
Mailing Address - Fax:918-560-0137
Practice Address - Street 1:11740 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-1820
Practice Address - Country:US
Practice Address - Phone:918-437-9495
Practice Address - Fax:918-234-4554
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3155104100000X
KS5112104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker