Provider Demographics
NPI:1558378125
Name:KROENERT, LINDY GRACE (MSW)
Entity Type:Individual
Prefix:
First Name:LINDY
Middle Name:GRACE
Last Name:KROENERT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-2705
Mailing Address - Country:US
Mailing Address - Phone:918-382-3100
Mailing Address - Fax:918-382-3188
Practice Address - Street 1:635 W 11TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9014
Practice Address - Country:US
Practice Address - Phone:918-382-3100
Practice Address - Fax:918-382-3188
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243516506Medicare PIN