MEDICARE: JO ANN JODY ANDERSON

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	101Y00000X	Counselor	2768	OK

General Provider Information

NPI Number	:	1972168359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO ANN JODY ANDERSON

Provider Business Mailing Address
First Line	:	3131 S MADISON AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-2035
Country	:	US
Telephone Number	:	918-381-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 S HARVARD AVE STE 110
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74114-6126
Country	:	US
Telephone Number	:	918-749-1840
Fax Number	:

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

Provider Enumeration Date	:	05/01/2019
Last Update Date	:	05/01/2019

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Directions to “ JO ANN JODY ANDERSON ” Practice Location

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