MEDICARE: JANICE L BIRDSONG MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	4292	OK

General Provider Information

NPI Number	:	1477710325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE L BIRDSONG MSW, LCSW

Provider Business Mailing Address
First Line	:	PO BOX 407
Second Line	:
City	:	MIAMI
State	:	OK
Zip	:	74354
Country	:	US
Telephone Number	:	405-605-3093
Fax Number	:	405-601-5628

Provider Business Practice Location Address
First Line	:	4911 N PORTLAND AVE STE 111
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-6170
Country	:	US
Telephone Number	:	405-605-3093
Fax Number	:	405-601-5682

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	01/18/2013

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