Provider Demographics
NPI:1285299008
Name:MADDAN, CATHERINE SHANON (LMSW-P U/S)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SHANON
Last Name:MADDAN
Suffix:
Gender:
Credentials:LMSW-P U/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 STATE HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:KANSAS
Mailing Address - State:OK
Mailing Address - Zip Code:74347-1640
Mailing Address - Country:US
Mailing Address - Phone:918-509-3528
Mailing Address - Fax:918-525-0013
Practice Address - Street 1:207 N HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:KANSAS
Practice Address - State:OK
Practice Address - Zip Code:74347
Practice Address - Country:US
Practice Address - Phone:918-786-4434
Practice Address - Fax:918-786-4435
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK21492-P104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator