Individual
LAINIEL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
504 S 4TH ST, LARAMIE, WY 82070-3704
(307) 761-2352
Mailing address
504 S 4TH ST, LARAMIE, WY 82070-3704
(307) 761-2352
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
Other
Enumeration date
11/12/2012
Last updated
02/09/2017
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