MEDICARE: MISS BRIDGET ANNE BROCK MS

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	101YS0200X	School Counselor

General Provider Information

NPI Number	:	1942483466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BRIDGET ANNE BROCK MS

Provider Business Mailing Address
First Line	:	2601 E 5TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-2905
Country	:	US
Telephone Number	:	918-833-9920
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 E 5TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-2905
Country	:	US
Telephone Number	:	918-833-9920
Fax Number	:

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

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	12/06/2007

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