Individual
DELANE TIDZUMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
#7 SHIPTON LANE, FORT WASHAKIE, WY 82514-0538
(307) 335-1169
(307) 335-1170
Mailing address
PO BOX 538, FORT WASHAKIE, WY 82514-0538
(307) 335-1169
(307) 335-1170
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
06/01/2016
Last updated
06/01/2016
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