Provider Demographics
NPI:1609894492
Name:VANDALL, DONNA KAY (LCSW)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:KAY
Last Name:VANDALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:KAY
Other - Last Name:RUMFELDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 52101
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74152-0101
Mailing Address - Country:US
Mailing Address - Phone:918-704-7402
Mailing Address - Fax:918-744-1596
Practice Address - Street 1:PO BOX 52101
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74152-0101
Practice Address - Country:US
Practice Address - Phone:918-704-7402
Practice Address - Fax:918-744-1596
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100222Medicare PIN