Individual provider · Type 1 NPI

Kennedy Mantrice Scullawl

Peer Specialist · Nowata, OK

NPI number 1093619652 Active

Practice location

325 S Ash St
Nowata, OK 74048-4628

Call (844) 458-2100 Map

Mailing address

200 Wauhillau Ct Apt 103
Nowata, OK 74048-2443

Specialties and licenses

TaxonomyCodeLicense
Peer Specialist Primary 175T00000XNone listed

Peer Specialist: Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

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About NPI 1093619652

Kennedy Mantrice Scullawl's National Provider Identifier is 1093619652, issued on Oct 6, 2026. The primary taxonomy on file is Peer Specialist (175T00000X), and the practice location is in Nowata, OK. The record was last updated on Oct 6, 2026.