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General NPI Number Information
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NPI Number | 1033676267
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Entity Type | Organization
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Legal Business Name | DIANA M. CLINE, LLC
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Dates
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Enumeration Date | 02/24/2019
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Last Update Date | 02/24/2019
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Provider Practice Location Address
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Address Line | 23 N SCOTT ST STE 21A
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City | SHERIDAN
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State | WY
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Zip | 82801-6338
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Country | US
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Telephone | 307-751-7916
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Fax | 307-672-8286
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Provider Business Mailing Address
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Address Line | PO BOX 7282
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City | SHERIDAN
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State | WY
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Zip | 82801-7005
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Country | US
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Telephone | 307-751-7916
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Fax | 307-672-8286
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Authorized Official
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Title or Position | OWNER
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Name | DIANA CLINE
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Credential | LCSW
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Telephone | 307-751-7916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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