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Individual

MRS. MONIQUE DESIREE VIDAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
2001 DEWAR DR STE 270, ROCK SPRINGS, WY 82901-5785
(605) 484-5258
Mailing address
3448 DOVER AVE, ROCK SPRINGS, WY 82901-5776
(605) 484-5258

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
818
WY
1041C0700X
Clinical Social Worker
PCSW-459
WY

Other

Enumeration date
01/13/2010
Last updated
03/16/2017
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