Provider Demographics
NPI:1063661767
Name:WILLMON-HAQUE, SADIE M
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:M
Last Name:WILLMON-HAQUE
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 1:2300 MCKOWN DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-6678
Mailing Address - Country:US
Mailing Address - Phone:405-321-3600
Mailing Address - Fax:405-321-3612
Practice Address - Street 1:2300 MCKOWN DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-6678
Practice Address - Country:US
Practice Address - Phone:405-321-3600
Practice Address - Fax:405-321-3612
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1165103T00000X
OK28911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical