Provider Demographics
NPI:1225355886
Name:NARDONI ISOM, ROSANNE (LPC)
Entity type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:NARDONI ISOM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ROSANNE
Other - Middle Name:
Other - Last Name:ISOM BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:505 SW 68TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-4307
Mailing Address - Country:US
Mailing Address - Phone:405-626-2544
Mailing Address - Fax:
Practice Address - Street 1:505 SW 68TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-4307
Practice Address - Country:US
Practice Address - Phone:405-626-2544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4133101YM0800X
OKLPC04133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2003647290AMedicaid