Provider Demographics
NPI:1285602417
Name:WHITTLESEY, SUZANNE W (LCSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:W
Last Name:WHITTLESEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18395
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73154-0395
Mailing Address - Country:US
Mailing Address - Phone:405-437-0014
Mailing Address - Fax:405-300-0704
Practice Address - Street 1:1900 E 15TH STREET
Practice Address - Street 2:BLDG. 600 STE C
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6610
Practice Address - Country:US
Practice Address - Phone:405-437-0014
Practice Address - Fax:405-300-0704
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical