Provider Demographics
NPI:1114154226
Name:BIBBO, MELISSA JEAN (MSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:BIBBO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JEAN
Other - Last Name:HATFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10208 E 100TH PL N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-7405
Mailing Address - Country:US
Mailing Address - Phone:603-303-1044
Mailing Address - Fax:
Practice Address - Street 1:650 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4429
Practice Address - Country:US
Practice Address - Phone:918-587-9471
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker