Healthcare Provider Details

I. General information

NPI: 1558411025
Provider Name (Legal Business Name): MICHAEL J BJORNSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOUSE AVE SUITE 201
CHEYENNE WY
82001-3176
US

IV. Provider business mailing address

PO BOX 20970
CHEYENNE WY
82003-7020
US

V. Phone/Fax

Practice location:
  • Phone: 307-638-7757
  • Fax: 307-638-8359
Mailing address:
  • Phone: 307-638-7757
  • Fax: 307-638-8359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number346718-2501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number465
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: