Healthcare Provider Details

I. General information

NPI: 1477707321
Provider Name (Legal Business Name): SHERI J FLUELLEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 E 17TH ST
CHEYENNE WY
82001-4711
US

IV. Provider business mailing address

719 E 17TH ST
CHEYENNE WY
82001-4711
US

V. Phone/Fax

Practice location:
  • Phone: 307-509-0772
  • Fax: 307-426-4133
Mailing address:
  • Phone: 307-509-0772
  • Fax: 307-426-4133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: