MEDICARE: MRS. STEPHANIE LIN KELLER CSW-099

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	099	WY
2	101Y00000X	Counselor	CSW-099	WY
3	1041C0700X	Clinical Social Worker	CSW-099	WY
4	104100000X	Social Worker	CSW-099	WY

General Provider Information

NPI Number	:	1124108931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE LIN KELLER CSW-099

Provider Business Mailing Address
First Line	:	4025 RAWLINS ST
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-1900
Country	:	US
Telephone Number	:	307-426-4798
Fax Number	:	307-426-4799

Provider Business Practice Location Address
First Line	:	4025 RAWLINS ST
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-1900
Country	:	US
Telephone Number	:	307-426-4798
Fax Number	:	307-426-4799

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	02/18/2021

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