Provider Demographics
NPI:1053542035
Name:SHADLOW, LADONNA KAY (CBHCM, BA)
Entity type:Individual
Prefix:
First Name:LADONNA
Middle Name:KAY
Last Name:SHADLOW
Suffix:
Gender:F
Credentials:CBHCM, BA
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 93
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-0093
Mailing Address - Country:US
Mailing Address - Phone:918-227-2016
Mailing Address - Fax:
Practice Address - Street 1:114 N GRAND AVE STE 418
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-4032
Practice Address - Country:US
Practice Address - Phone:918-227-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker