Healthcare Provider Details

I. General information

NPI: 1750291878
Provider Name (Legal Business Name): COLEEN ANN FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 EMERALD AVE
GILLETTE WY
82716-9796
US

IV. Provider business mailing address

22 EMERALD AVE
GILLETTE WY
82716-9796
US

V. Phone/Fax

Practice location:
  • Phone: 307-299-5452
  • Fax:
Mailing address:
  • Phone: 307-266-5452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: