Provider Demographics
NPI:1912551805
Name:HAWKINS, ESTELLE
Entity Type:Individual
Prefix:
First Name:ESTELLE
Middle Name:
Last Name:HAWKINS
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 1:21227 N COUNTY ROAD 3350
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:OK
Mailing Address - Zip Code:73098-9356
Mailing Address - Country:US
Mailing Address - Phone:405-207-0116
Mailing Address - Fax:
Practice Address - Street 1:21227 N COUNTY ROAD 3350
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:OK
Practice Address - Zip Code:73098-9356
Practice Address - Country:US
Practice Address - Phone:140-520-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility