MEDICARE: MRS. DONNA DOSS BOSWELL LCSW

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	1041C0700X	Clinical Social Worker	2361	OK

General Provider Information

NPI Number	:	1316023393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA DOSS BOSWELL LCSW

Provider Business Mailing Address
First Line	:	3223 E. 31ST STREET
Second Line	:	SUITE 201
City	:	TULSA
State	:	OK
Zip	:	74105
Country	:	US
Telephone Number	:	918-749-6935
Fax Number	:	918-749-7611

Provider Business Practice Location Address
First Line	:	3223 E 31ST ST
Second Line	:	SUITE 201
City	:	TULSA
State	:	OK
Zip	:	74105-2452
Country	:	US
Telephone Number	:	918-749-6935
Fax Number	:	918-749-7611

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/08/2007

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