Provider Demographics
NPI:1518250810
Name:WOLFGRAM, ROBIN ELIZABETH (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:ELIZABETH
Last Name:WOLFGRAM
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ABERDEEN PL
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2267
Mailing Address - Country:US
Mailing Address - Phone:314-341-4309
Mailing Address - Fax:314-361-2052
Practice Address - Street 1:4561 S COMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111-1554
Practice Address - Country:US
Practice Address - Phone:314-341-4309
Practice Address - Fax:314-361-2052
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090103321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical