Healthcare Provider Details

I. General information

NPI: 1881317998
Provider Name (Legal Business Name): PROF. FELICE ANN ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 HARDER DR
GILLETTE WY
82718-6136
US

IV. Provider business mailing address

2917 HARDER DR
GILLETTE WY
82718-6136
US

V. Phone/Fax

Practice location:
  • Phone: 307-299-3226
  • Fax:
Mailing address:
  • Phone: 307-299-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1301
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: