Provider Demographics
NPI:1407193550
Name:SMITH, WANDA DENICE
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:DENICE
Last Name:SMITH
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 1:2416 SW OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-0802
Mailing Address - Country:US
Mailing Address - Phone:580-574-4775
Mailing Address - Fax:
Practice Address - Street 1:2416 SW OXFORD DR
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-0802
Practice Address - Country:US
Practice Address - Phone:580-574-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional