Healthcare Provider Details

I. General information

NPI: 1407776685
Provider Name (Legal Business Name): AMANDA WALDRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W 2ND ST # A685
CASPER WY
82601-2412
US

IV. Provider business mailing address

312 W 2ND ST # A685
CASPER WY
82601-2412
US

V. Phone/Fax

Practice location:
  • Phone: 307-253-9308
  • Fax: 307-215-5521
Mailing address:
  • Phone: 307-253-9308
  • Fax: 307-215-5521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: