Individual
AMY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1911 E 22ND ST, CHEYENNE, WY 82001-4142
(307) 631-6250
Mailing address
1911 E 22ND ST, CHEYENNE, WY 82001-4142
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
12/10/2015
Last updated
12/10/2015
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