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1629528302
SHANNON DEATHERAGE
ADA, OK
NPI
1629528302
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
104100000X Social Worker
Enumeration Date
2016-10-06
Last Update Date
2016-10-06
Business Address
-- SHANNON DEATHERAGE BSW
3115 ARLINGTON ST
ADA, OK 74820-3085
Phone number: 580-332-6345
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Mailing Address
-- SHANNON DEATHERAGE BSW
2119 HAWK CIR
ADA, OK 74820-6001
Phone number: 580-332-6345
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