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NPI Code Detail

MEDICARE: DONALD ANDERSON LCSW

MEDICARE: DONALD ANDERSON 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
11041C0700XClinical Social Worker3090OK

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00257069OTHERMEDICARE RR

General Provider Information

NPI Number : 1083655021
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONALD ANDERSON LCSW
Provider Business Mailing Address
First Line : 4001 KNIGHTS BRIDGE ST
Second Line :
City : NORMAN
State : OK
Zip : 73072-1743
Country : US
Telephone Number : 405-573-9905
Fax Number : 405-573-0404
Provider Business Practice Location Address
First Line : 5725 S ROSS AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73119-5650
Country : US
Telephone Number : 405-685-4791
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2006
Last Update Date : 12/16/2009

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