Healthcare Provider Details

I. General information

NPI: 1003543844
Provider Name (Legal Business Name): ALYSSA NICOLE BJORKQUIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 CAPITOL AVE STE 109
CHEYENNE WY
82001-4558
US

IV. Provider business mailing address

1807 CAPITOL AVE STE 109
CHEYENNE WY
82001-4558
US

V. Phone/Fax

Practice location:
  • Phone: 307-256-6467
  • Fax:
Mailing address:
  • Phone: 307-256-6467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPCSW-1043
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: