Healthcare Provider Details

I. General information

NPI: 1558084616
Provider Name (Legal Business Name): AMANDA GASKIN PCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E 7TH ST
POWELL WY
82435-2126
US

IV. Provider business mailing address

1201 E 7TH ST
POWELL WY
82435-2126
US

V. Phone/Fax

Practice location:
  • Phone: 307-764-4107
  • Fax:
Mailing address:
  • Phone: 307-764-4107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1055
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-72643
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-1667
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: