MEDICARE: MISS ERIN AIMEE KOOS 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	3616	OK

General Provider Information

NPI Number	:	1073722666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ERIN AIMEE KOOS LCSW

Provider Business Mailing Address
First Line	:	2554 NW 18TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-3933
Country	:	US
Telephone Number	:	405-323-8860
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 NE 15TH ST
Second Line	:	ROB-426
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-4614
Country	:	US
Telephone Number	:	405-271-2474
Fax Number	:	405-271-6236

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	11/05/2009

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