Provider Demographics
NPI:1598036055
Name:DEWANE, SHARLEEN LOUISE
Entity Type:Individual
Prefix:
First Name:SHARLEEN
Middle Name:LOUISE
Last Name:DEWANE
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 1:5546 N PORTLAND AVE
Mailing Address - Street 2:APT 260
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1913
Mailing Address - Country:US
Mailing Address - Phone:405-837-7614
Mailing Address - Fax:
Practice Address - Street 1:5546 N PORTLAND AVE
Practice Address - Street 2:APT 260
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1913
Practice Address - Country:US
Practice Address - Phone:405-837-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-14
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation