Provider Demographics
NPI:1457625915
Name:FLANDERS, IVY
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:FLANDERS
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 1:819 NW 31ST ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5142
Mailing Address - Country:US
Mailing Address - Phone:580-355-0072
Mailing Address - Fax:
Practice Address - Street 1:602 SW A AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3930
Practice Address - Country:US
Practice Address - Phone:580-355-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker