Healthcare Provider Details

I. General information

NPI: 1659887040
Provider Name (Legal Business Name): LINDA MARIE TRUJILLO PCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 W PERSHING BLVD
CHEYENNE WY
82001-2537
US

IV. Provider business mailing address

PO BOX 20970
CHEYENNE WY
82003-7020
US

V. Phone/Fax

Practice location:
  • Phone: 307-638-4625
  • Fax: 307-635-3965
Mailing address:
  • Phone: 307-773-8237
  • Fax: 307-773-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number758
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: