Provider Demographics
NPI:1124291513
Name:DONNA VANDALL, INC.
Entity type:Organization
Organization Name:DONNA VANDALL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:RUMFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-749-6935
Mailing Address - Street 1:3223 E 31ST ST STE 201
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2444
Mailing Address - Country:US
Mailing Address - Phone:918-749-6935
Mailing Address - Fax:918-749-7611
Practice Address - Street 1:3223 E 31ST ST STE 201
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2444
Practice Address - Country:US
Practice Address - Phone:918-749-6935
Practice Address - Fax:918-749-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK45431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty