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General NPI Number Information
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NPI Number | 1639328040
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Entity Type | Organization
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Legal Business Name | ANNE C FITZGERALD, PHD, LLC
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 1465 N 4TH ST STE 113
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City | LARAMIE
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State | WY
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Zip | 82072-2066
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Country | US
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Telephone | 73-997-4993
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Fax | 307-745-3221
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Provider Business Mailing Address
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Address Line | 1465 N 4TH ST STE 113
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City | LARAMIE
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State | WY
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Zip | 82072-2066
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Country | US
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Telephone | 73-997-4993
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Fax | 307-745-3221
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Authorized Official
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Title or Position | OWNER-PROVIDER
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Name | DR. ANNE CATHERINE FITZGERALD
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Credential | PHD
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Telephone | 307-399-7499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 308
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License Number State | WY
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