Individual
DEBRA ANN HATHCOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
724 W SNOW KING AVE # 7825, JACKSON, WY 83001-8498
(307) 690-6505
Mailing address
PO BOX 7825, JACKSON, WY 83002-7825
(307) 690-6505
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/29/2018
Last updated
08/29/2018
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