MEDICARE: MRS. JULIE TRACHTENBERG D'AMOURS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	PCSW-1277	WY

General Provider Information

NPI Number	:	1225992548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE TRACHTENBERG D'AMOURS

Provider Business Mailing Address
First Line	:	PO BOX 392
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-0392
Country	:	US
Telephone Number	:	307-413-3088
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 E BROADWAY AVE STE B11
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-8632
Country	:	US
Telephone Number	:	307-203-5002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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