Healthcare Provider Details

I. General information

NPI: 1780097709
Provider Name (Legal Business Name): KRISTLE J WOLFF CLINICAL SOCIAL WORK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTLE WESTOVER

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 PETERSEN PKWY
THAYNE WY
83127-9755
US

IV. Provider business mailing address

901 ADAMS ST
AFTON WY
83110-9621
US

V. Phone/Fax

Practice location:
  • Phone: 307-883-5852
  • Fax:
Mailing address:
  • Phone: 307-885-5800
  • Fax: 307-885-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPCSW582
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: