Healthcare Provider Details

I. General information

NPI: 1306380696
Provider Name (Legal Business Name): ALEXANDRA GILL CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 EAST 1-80 SERVICE RD.
CHEYENNE WY
82009
US

IV. Provider business mailing address

3304 E. 1-80 SERVICE RD.
CHEYENNE WY
82009-4711
US

V. Phone/Fax

Practice location:
  • Phone: 307-829-7355
  • Fax:
Mailing address:
  • Phone: 307-829-7355
  • Fax: 307-426-4133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-267
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: