Provider Demographics
NPI:1750818738
Name:WOODFORK, LATOYA STACY ANN (CASE MANAGER II)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:STACY ANN
Last Name:WOODFORK
Suffix:
Gender:F
Credentials:CASE MANAGER II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E. ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-2336
Mailing Address - Country:US
Mailing Address - Phone:405-406-6165
Mailing Address - Fax:
Practice Address - Street 1:1120 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5300
Practice Address - Country:US
Practice Address - Phone:405-573-3812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator