Provider Demographics
NPI:1902219546
Name:LEROUX, SHERI
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:
Last Name:LEROUX
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 1:3610 NE BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-1972
Mailing Address - Country:US
Mailing Address - Phone:580-574-0230
Mailing Address - Fax:
Practice Address - Street 1:3610 NE BRADFORD ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-1972
Practice Address - Country:US
Practice Address - Phone:580-574-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker