Provider Demographics
NPI:1043980964
Name:SNOW, ALISHA MAE
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:MAE
Last Name:SNOW
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 1:704 SW 4TH PL
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2315
Mailing Address - Country:US
Mailing Address - Phone:405-274-4694
Mailing Address - Fax:
Practice Address - Street 1:1215 NW 25TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5629
Practice Address - Country:US
Practice Address - Phone:405-525-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator