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NPI Code Detail

MEDICARE: JANICE L. KIMBALL LCSW

MEDICARE: JANICE L. KIMBALL 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 Worker3608OK

General Provider Information

NPI Number : 1629128301
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANICE L. KIMBALL LCSW
Provider Business Mailing Address
First Line : 3000 W MEMORIAL RD STE 218
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-6103
Country : US
Telephone Number : 405-400-9991
Fax Number :
Provider Business Practice Location Address
First Line : 3000 W MEMORIAL RD STE 218
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-6103
Country : US
Telephone Number : 405-400-9991
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2007
Last Update Date : 07/23/2020

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