MEDICARE: SUZANNE W WHITTLESEY 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	65	OK

General Provider Information

NPI Number	:	1285602417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE W WHITTLESEY LCSW

Provider Business Mailing Address
First Line	:	PO BOX 18395
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73154-0395
Country	:	US
Telephone Number	:	405-437-0014
Fax Number	:	405-300-0704

Provider Business Practice Location Address
First Line	:	1900 E 15TH STREET
Second Line	:	BLDG. 600 STE C
City	:	EDMOND
State	:	OK
Zip	:	73013-6610
Country	:	US
Telephone Number	:	405-437-0014
Fax Number	:	405-300-0704

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	05/31/2019

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