Provider Demographics
NPI:1710347828
Name:WOLF TEDDER, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:WOLF TEDDER
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 1:15500 JEFFERSONS GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1410
Mailing Address - Country:US
Mailing Address - Phone:405-330-8200
Mailing Address - Fax:
Practice Address - Street 1:624 W INDEPENDENCE ST STE 105
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-4329
Practice Address - Country:US
Practice Address - Phone:405-279-9416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional