Healthcare Provider Details

I. General information

NPI: 1194019596
Provider Name (Legal Business Name): TONIE MARIE RATLIFF CSW - 121
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONIE MARIE FEATHERINGILL CSW - 121

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 MAIN ST
LANDER WY
82520-3036
US

IV. Provider business mailing address

748 MAIN ST
LANDER WY
82520-3036
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-2231
  • Fax: 307-332-9338
Mailing address:
  • Phone: 307-332-2231
  • Fax: 307-332-9338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-121
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: