Individual
KAITLYNN SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
201 W LAKEWAY RD STE 600, GILLETTE, WY 82718-6314
(307) 299-3386
Mailing address
4539 WILSON WAY, GILLETTE, WY 82718-4034
(307) 299-3386
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
PPC-1501
WY
Other
Enumeration date
09/19/2024
Last updated
09/19/2024
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