Provider Demographics
NPI:1336356245
Name:DAVIS, ROBYN S (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:S
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:S
Other - Last Name:KRAUTKRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 CROWN RD
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-6524
Mailing Address - Country:US
Mailing Address - Phone:618-988-8349
Mailing Address - Fax:
Practice Address - Street 1:109 LOU ANN DR
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3733
Practice Address - Country:US
Practice Address - Phone:618-988-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical