Provider Demographics
NPI:1851622799
Name:SHRADER, AMANDA REED (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:REED
Last Name:SHRADER
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 1:3000 W MEMORIAL RD STE 123
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-6108
Mailing Address - Country:US
Mailing Address - Phone:405-237-8609
Mailing Address - Fax:
Practice Address - Street 1:15504 BLUE MESA DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-8848
Practice Address - Country:US
Practice Address - Phone:405-237-8609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical