Provider Demographics
NPI:1083984520
Name:ESCAJEDA, VICKI LYN
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYN
Last Name:ESCAJEDA
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 1:7600 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4944
Mailing Address - Country:US
Mailing Address - Phone:405-792-7425
Mailing Address - Fax:405-604-6040
Practice Address - Street 1:7600 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4944
Practice Address - Country:US
Practice Address - Phone:405-792-7425
Practice Address - Fax:405-604-6040
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker