Provider Demographics
NPI:1821560061
Name:CHAISSON, LETTIE R
Entity Type:Individual
Prefix:
First Name:LETTIE
Middle Name:R
Last Name:CHAISSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LETTIE
Other - Middle Name:R
Other - Last Name:LAAKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4906 GRANVILLE LN
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3740
Mailing Address - Country:US
Mailing Address - Phone:580-334-5333
Mailing Address - Fax:
Practice Address - Street 1:1222 10TH ST STE 211
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3156
Practice Address - Country:US
Practice Address - Phone:580-256-8615
Practice Address - Fax:580-256-8609
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker