MEDICARE: CHAWNA LEQUEESE ROBERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	106S00000X	Behavior Technician		OK

General Provider Information

NPI Number	:	1871812198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAWNA LEQUEESE ROBERSON

Provider Business Mailing Address
First Line	:	7605 EASTGATE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-6259
Country	:	US
Telephone Number	:	405-300-3519
Fax Number	:

Provider Business Practice Location Address
First Line	:	13905 TECHNOLOGY DR # A1
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1054
Country	:	US
Telephone Number	:	405-398-4530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2010
Last Update Date	:	11/17/2021

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