Provider Demographics
NPI:1437535002
Name:BIRDWELL, ELODIE (MSW)
Entity Type:Individual
Prefix:
First Name:ELODIE
Middle Name:
Last Name:BIRDWELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 E KNOXVILLE ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-2813
Mailing Address - Country:US
Mailing Address - Phone:918-519-8735
Mailing Address - Fax:
Practice Address - Street 1:2804 E KNOXVILLE ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-2813
Practice Address - Country:US
Practice Address - Phone:918-519-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5185-P104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker