Provider Demographics
NPI:1164069258
Name:SCHLUMPBERGER, MARY MADONNA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MADONNA
Last Name:SCHLUMPBERGER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:MADONNA
Other - Last Name:ENANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LMSW
Mailing Address - Street 1:1624 CIMARRON PLZ
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-3467
Mailing Address - Country:US
Mailing Address - Phone:405-372-2202
Mailing Address - Fax:
Practice Address - Street 1:1624 CIMARRON PLZ
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-3467
Practice Address - Country:US
Practice Address - Phone:405-372-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-08
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6569-P1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical