MEDICARE: JAYDE ELAYNE AGBO

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	21945	OK

General Provider Information

NPI Number	:	1154817542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYDE ELAYNE AGBO

Provider Business Mailing Address
First Line	:	3100 MEDICAL PKWY
Second Line	:
City	:	CLAREMORE
State	:	OK
Zip	:	74017-1088
Country	:	US
Telephone Number	:	918-934-8235
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 MEDICAL PKWY
Second Line	:
City	:	CLAREMORE
State	:	OK
Zip	:	74017-1088
Country	:	US
Telephone Number	:	918-934-8235
Fax Number	:

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

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	01/12/2026

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