Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | PPC-561 | WY |
NPI | 1003101742 |
---|---|
Provider Name | Miss Jane Elizabeth Matthews |
First Address | Casper, WY 82601-1336 |
Second Address | Casper, WY 82601-1336 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2011 |
Last Update Date | 10/06/2011 |