Healthcare Provider Details

I. General information

NPI: 1053832386
Provider Name (Legal Business Name): MARY GETRUDE CAULFIELD MSH, LAT, MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LANE LN
SHERIDAN WY
82801-8630
US

IV. Provider business mailing address

5 LANE LN
SHERIDAN WY
82801-8630
US

V. Phone/Fax

Practice location:
  • Phone: 307-675-4100
  • Fax:
Mailing address:
  • Phone: 307-675-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number368
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: