Provider Demographics
NPI:1821235730
Name:SKENDER, RANDI DENISE I
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:DENISE
Last Name:SKENDER
Suffix:I
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 1:210 E. MAIN ST.
Mailing Address - Street 2:RESOURCE MANAGEMENT
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:580-436-7211
Mailing Address - Fax:580-272-5757
Practice Address - Street 1:1921 STONECIPHER BLVD.
Practice Address - Street 2:CHICKASAW NATION MEDICAL CENTER
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820
Practice Address - Country:US
Practice Address - Phone:580-436-3980
Practice Address - Fax:580-421-6283
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
OK39271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PHS000OtherOTHER