Individual
ROBERT BRAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT
Contact information
Practice address
610 W BROADWAY AVE STE L1, JACKSON, WY 83001-8213
(307) 733-3908
(307) 734-0017
Mailing address
PO BOX 11390, JACKSON, WY 83002-1390
(307) 733-3908
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LAT-202
WY
Other
Enumeration date
12/11/2013
Last updated
12/11/2013
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