Provider Demographics
NPI:1750886461
Name:JACKSON SOKOLOSKY, DANIELLE SHEA
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SHEA
Last Name:JACKSON SOKOLOSKY
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 1:1817 GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-6111
Mailing Address - Country:US
Mailing Address - Phone:918-917-0500
Mailing Address - Fax:
Practice Address - Street 1:1817 GLENDALE RD
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-6111
Practice Address - Country:US
Practice Address - Phone:918-917-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst