Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCSW-1159 | WY |
NPI | 1003265067 |
---|---|
Provider Name | Nolan Marie Vitzthum |
First Address | Cheyenne, WY 82001-1900 |
Second Address | Cheyenne, WY 82001-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2016 |
Last Update Date | 24/01/2019 |