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General NPI Number Information
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NPI Number | 1760869572
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Entity Type | Individual
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Provider Name | REBECCA LOGSDON-DOUGHERTY
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Gender | Female
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 3001 HENDERSON DR STE N
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City | CHEYENNE
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State | WY
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Zip | 82001-5840
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Country | US
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Telephone | 307-632-7993
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Fax | 307-632-1330
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Provider Business Mailing Address
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Address Line | 809 S 9TH ST
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City | DOUGLAS
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State | WY
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Zip | 82633-2959
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Country | US
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Telephone | 307-632-7993
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Fax | 307-632-1330
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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