Provider Demographics
NPI:1407601149
Name:KAKISH, EMILY ROSE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:KAKISH
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 1:1000 NE 13TH ST STE 1G
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5040
Mailing Address - Country:US
Mailing Address - Phone:405-271-3445
Mailing Address - Fax:405-271-3401
Practice Address - Street 1:1000 NE 13TH ST STE 1G
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5040
Practice Address - Country:US
Practice Address - Phone:405-271-3445
Practice Address - Fax:405-271-3401
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK202701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical