Provider Demographics
NPI:1952652133
Name:RIDGWAY, SHYLAH KAY (LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:SHYLAH
Middle Name:KAY
Last Name:RIDGWAY
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 W OWEN K GARRIOTT RD # 1008
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-4907
Mailing Address - Country:US
Mailing Address - Phone:978-219-2681
Mailing Address - Fax:877-265-2920
Practice Address - Street 1:605 W OXFORD AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-1208
Practice Address - Country:US
Practice Address - Phone:580-233-7220
Practice Address - Fax:580-237-7550
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
OK56441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker