Provider Demographics
NPI:1568628758
Name:EDWARDS, SANDRA LINN
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LINN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4642
Mailing Address - Country:US
Mailing Address - Phone:405-372-0198
Mailing Address - Fax:405-372-0283
Practice Address - Street 1:801 S MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4642
Practice Address - Country:US
Practice Address - Phone:405-372-0198
Practice Address - Fax:405-372-0283
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100730950Medicaid