MEDICARE: MRS. DONNA S ROBILLARD MSW, 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	1772	OK

General Provider Information

NPI Number	:	1396851010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA S ROBILLARD MSW, LCSW

Provider Business Mailing Address
First Line	:	4401 W MEMORIAL RD
Second Line	:	SUITE 143
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1785
Country	:	US
Telephone Number	:	405-486-8600
Fax Number	:	405-752-3598

Provider Business Practice Location Address
First Line	:	4401 W MEMORIAL RD
Second Line	:	SUITE 143
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1785
Country	:	US
Telephone Number	:	405-486-8600
Fax Number	:	405-752-3598

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	01/31/2014

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