Provider Demographics
NPI:1124191580
Name:FERGUSON, JEANNE E (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:E
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 N PENNSYLVANIA
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-848-6565
Mailing Address - Fax:405-848-4544
Practice Address - Street 1:5015 N PENNSYLVANIA
Practice Address - Street 2:SUITE 201
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-848-6565
Practice Address - Fax:405-848-4544
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1980104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker