Provider Demographics
NPI:1902816846
Name:DOGGETT, ROXANNE BENAD
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:BENAD
Last Name:DOGGETT
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 1:930 S BOULEVARD ST
Mailing Address - Street 2:#229
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4724
Mailing Address - Country:US
Mailing Address - Phone:405-301-3965
Mailing Address - Fax:
Practice Address - Street 1:930 S BOULEVARD ST
Practice Address - Street 2:#229
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4724
Practice Address - Country:US
Practice Address - Phone:405-301-3965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health