MEDICARE: MINDEE MARLER PCSW

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	104100000X	Social Worker	PCSW-719	WY
2	104100000X	Social Worker	LCSW-2142	WY

General Provider Information

NPI Number	:	1295273498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINDEE MARLER PCSW

Provider Business Mailing Address
First Line	:	350 CITY VIEW DR STE 206
Second Line	:
City	:	EVANSTON
State	:	WY
Zip	:	82930-5326
Country	:	US
Telephone Number	:	307-789-7915
Fax Number	:	307-789-6009

Provider Business Practice Location Address
First Line	:	350 CITY VIEW DR STE 206
Second Line	:
City	:	EVANSTON
State	:	WY
Zip	:	82930-5326
Country	:	US
Telephone Number	:	307-789-7915
Fax Number	:	307-789-6009

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

Provider Enumeration Date	:	02/08/2017
Last Update Date	:	03/27/2023

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