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Individual

CANDICE RAE GRONBERG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
4 ROBERTS ROAD, LANDER, WY 82520-1401
(307) 332-9122
(307) 332-9122
Mailing address
PO BOX 1401, 4 ROBERTS ROAD, LANDER, WY 82520-1401
(307) 332-9122
(307) 332-9122

Taxonomy

Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
114858300
WY

Other

Enumeration date
04/28/2011
Last updated
04/28/2011
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