Melissa Ann Broaddus, MSW
Individual provider Active NPI Social Worker · Jenks, OK
NPI 1730438383 · NPPES record last updated Aug 29, 2012
Key facts
- NPI
- 1730438383
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- Practice address
- 11507 S Locust Ave
Jenks, OK 74037-2174 - Phone
- (918) 698-6649
- NPI assigned
- Aug 29, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | Yes |
Addresses
Primary practice location
11507 S Locust Ave
Jenks, OK 74037-2174
Mailing address
11507 S Locust Ave
Jenks, OK 74037-2174
Phone (918) 698-6649
Other providers in Jenks, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.