Provider Demographics
NPI:1972244473
Name:EAST, SUSAN ASHLEY
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ASHLEY
Last Name:EAST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:EAST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25604 MURPHY CT
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-4504
Mailing Address - Country:US
Mailing Address - Phone:918-557-2532
Mailing Address - Fax:
Practice Address - Street 1:25604 MURPHY CT
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019-4504
Practice Address - Country:US
Practice Address - Phone:918-557-2532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK416070103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK416070OtherOKLAHOMA STATE DEPARTMENT OF EDUCATION