Healthcare Provider Details

I. General information

NPI: 1114209350
Provider Name (Legal Business Name): SHAUN RICHEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 COUNTRY CLUB LN.
PINEDALE WY
82941
US

IV. Provider business mailing address

1111 MOUNTAIN MEADOW AVE
PINEDALE WY
82941-5348
US

V. Phone/Fax

Practice location:
  • Phone: 307-367-2111
  • Fax:
Mailing address:
  • Phone: 307-367-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: