Individual
CAROLJEAN BONGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
2909 BENT AVE, CHEYENNE, WY 82001-2742
(307) 760-1871
(866) 621-1893
Mailing address
PO BOX 21270, CHEYENNE, WY 82003-7025
(307) 760-1871
(866) 621-1893
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
432
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124350100
—
WY
Enumeration date
09/25/2006
Last updated
07/21/2022
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