Healthcare Provider Details

I. General information

NPI: 1043756174
Provider Name (Legal Business Name): MARIBETH L. HESSER PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETSY HESSER PSY.D

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6675 N UPPER CASCADE DR
JACKSON WY
83001-9390
US

IV. Provider business mailing address

6675 N UPPER CASCADE DR
JACKSON WY
83001-9390
US

V. Phone/Fax

Practice location:
  • Phone: 307-690-3043
  • Fax:
Mailing address:
  • Phone: 307-690-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number387
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number387
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: