Provider Demographics
NPI:1942697917
Name:HENSON, MARTHA SUE
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:SUE
Last Name:HENSON
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 1:3322 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-6108
Mailing Address - Country:US
Mailing Address - Phone:918-955-6245
Mailing Address - Fax:
Practice Address - Street 1:3322 E 30TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-6108
Practice Address - Country:US
Practice Address - Phone:918-955-6245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management