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General NPI Number Information
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NPI Number | 1306130901
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Entity Type | Individual
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Provider Name | JADE M BENNIGHT LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 02/04/2020
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Provider Practice Location Address
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Address Line | 5101 SHADES BRIDGE RD
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City | EDMOND
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State | OK
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Zip | 73034-0854
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Country | US
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Telephone | 580-583-4467
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Fax |
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Provider Business Mailing Address
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Address Line | 5101 SHADES BRIDGE RD
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City | EDMOND
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State | OK
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Zip | 73034-0854
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Country | US
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Telephone | 405-974-2215
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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