Provider Demographics
NPI:1679315089
Name:ALOG, ANGELIQUE JOIS LEMQUE
Entity type:Individual
Prefix:
First Name:ANGELIQUE JOIS
Middle Name:LEMQUE
Last Name:ALOG
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 1:3214 N YOUNGS BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7834
Mailing Address - Country:US
Mailing Address - Phone:580-583-5488
Mailing Address - Fax:
Practice Address - Street 1:3214 N YOUNGS BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7834
Practice Address - Country:US
Practice Address - Phone:580-583-5488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator