Healthcare Provider Details

I. General information

NPI: 1932808698
Provider Name (Legal Business Name): TANEESA CONGDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 HILLTOP DR STE 103
ROCK SPRINGS WY
82901-5858
US

IV. Provider business mailing address

1208 HILLTOP DR STE 103
ROCK SPRINGS WY
82901-5858
US

V. Phone/Fax

Practice location:
  • Phone: 307-212-8014
  • Fax: 307-224-2128
Mailing address:
  • Phone: 307-212-8014
  • Fax: 307-224-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPCSW1078
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: