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General NPI Number Information
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NPI Number | 1821805375
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Entity Type | Individual
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Provider Name | SCOTT GORDON ANDERSON
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Gender | Male
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 450 S FEDERAL BLVD
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City | RIVERTON
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State | WY
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Zip | 82501-4711
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Country | US
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Telephone | 307-856-8090
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Fax | 307-463-4254
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | ST STEPHENS
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State | WY
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Zip | 82524-0190
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Country | US
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Telephone | 307-856-8090
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Fax | 307-463-4254
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 177
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License Number State | WY
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