Provider Demographics
NPI:1477710325
Name:BIRDSONG, JANICE L (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:BIRDSONG
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354
Mailing Address - Country:US
Mailing Address - Phone:405-605-3093
Mailing Address - Fax:405-601-5628
Practice Address - Street 1:4911 N PORTLAND AVE STE 111
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6170
Practice Address - Country:US
Practice Address - Phone:405-605-3093
Practice Address - Fax:405-601-5682
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK42921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical