MEDICARE: KRISTEN K RIGONI LCSW #542

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	1041C0700X	Clinical Social Worker	542	WY

General Provider Information

NPI Number	:	1740266741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN K RIGONI LCSW #542

Provider Business Mailing Address
First Line	:	1000 E UNIVERSITY AVE DEPT 3195
Second Line	:	KNIGHT HALL 222
City	:	LARAMIE
State	:	WY
Zip	:	82071-2000
Country	:	US
Telephone Number	:	307-766-2398
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 E UNIVERSITY AVE DEPT 3195
Second Line	:	KNIGHT HALL 222
City	:	LARAMIE
State	:	WY
Zip	:	82071-2000
Country	:	US
Telephone Number	:	307-766-2398
Fax Number	:

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	03/06/2009

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