Provider Demographics
NPI:1205467263
Name:SCOWDEN, TRACIE
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:SCOWDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:
Other - Last Name:DIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2240 36TH AVE NW # 100
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2240 36TH AVE NW # 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-3251
Practice Address - Country:US
Practice Address - Phone:405-253-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician