Provider Demographics
NPI:1457457624
Name:MARLETT, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:MARLETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 NW 64TH ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1684
Mailing Address - Country:US
Mailing Address - Phone:405-842-4911
Mailing Address - Fax:
Practice Address - Street 1:4045 NW 64TH ST
Practice Address - Street 2:SUITE 520
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1684
Practice Address - Country:US
Practice Address - Phone:405-842-4911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK03751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical