Provider Demographics
NPI:1386929370
Name:VAZQUEZ, PATTI JO (LCSWUNDER SUPERVISI)
Entity type:Individual
Prefix:MISS
First Name:PATTI
Middle Name:JO
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:LCSWUNDER SUPERVISI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 NICKERSON ST
Mailing Address - Street 2:
Mailing Address - City:WAYNOKA
Mailing Address - State:OK
Mailing Address - Zip Code:73860-1252
Mailing Address - Country:US
Mailing Address - Phone:580-334-9924
Mailing Address - Fax:
Practice Address - Street 1:1095 NICKERSON ST
Practice Address - Street 2:
Practice Address - City:WAYNOKA
Practice Address - State:OK
Practice Address - Zip Code:73860-1252
Practice Address - Country:US
Practice Address - Phone:580-334-9924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical