Provider Demographics
NPI:1700387420
Name:TOLLEFSON, ROBYN JO
Entity Type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:JO
Last Name:TOLLEFSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:JO
Other - Last Name:BLODGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:619 W MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-7626
Mailing Address - Country:US
Mailing Address - Phone:918-210-1025
Mailing Address - Fax:
Practice Address - Street 1:619 W MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-7626
Practice Address - Country:US
Practice Address - Phone:918-210-1025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator