Healthcare Provider Details

I. General information

NPI: 1972734283
Provider Name (Legal Business Name): ANGELENE J ROUNDS M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 FOOTHILL BLVD
ROCK SPRINGS WY
82901-5610
US

IV. Provider business mailing address

2300 FOOTHILL BLVD
ROCK SPRINGS WY
82901-5610
US

V. Phone/Fax

Practice location:
  • Phone: 307-352-6677
  • Fax: 307-652-6614
Mailing address:
  • Phone: 307-352-6677
  • Fax: 307-652-6614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberPCSW-391
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: