Provider Demographics
NPI:1346282696
Name:WATKINS, STEPHANIE SUSANNE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SUSANNE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:SUSANNE
Other - Last Name:CHALK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14660 W 18TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-4405
Mailing Address - Country:US
Mailing Address - Phone:918-639-6887
Mailing Address - Fax:918-241-2638
Practice Address - Street 1:208 N MAIN
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063
Practice Address - Country:US
Practice Address - Phone:918-514-4029
Practice Address - Fax:918-419-2653
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK39021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical