Individual
HEAVEN ELSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1206 22ND ST APT 1, WHEATLAND, WY 82201-2426
(307) 331-5658
Mailing address
1206 22ND ST APT 1, WHEATLAND, WY 82201-2426
(307) 331-5658
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/10/2026
Last updated
07/10/2026
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