Provider Demographics
NPI:1841608585
Name:STROUD, STEPHANIE (BA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:STROUD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 E SHAWNEE ST
Mailing Address - Street 2:APT. A2
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3353
Mailing Address - Country:US
Mailing Address - Phone:918-839-6565
Mailing Address - Fax:
Practice Address - Street 1:11740 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-1820
Practice Address - Country:US
Practice Address - Phone:918-437-9495
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator