Healthcare Provider Details

I. General information

NPI: 1710605050
Provider Name (Legal Business Name): FREMONT COUNTY SCHOOL DISTRICT 25
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N 5TH ST W
RIVERTON WY
82501-3453
US

IV. Provider business mailing address

121 N 5TH ST W
RIVERTON WY
82501-3453
US

V. Phone/Fax

Practice location:
  • Phone: 307-856-5250
  • Fax:
Mailing address:
  • Phone: 307-856-5250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MS. RENEE M HOESEL
Title or Position: SPECIAL SERVICES SECRETARY
Credential:
Phone: 307-856-5250