Provider Demographics
NPI:1205636826
Name:HANLON, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:HANLON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:823 N VILLA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-6439
Mailing Address - Country:US
Mailing Address - Phone:405-620-2283
Mailing Address - Fax:
Practice Address - Street 1:823 N VILLA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-6439
Practice Address - Country:US
Practice Address - Phone:405-620-2283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator