Basic Information
| Provider Information | |||||||||
| NPI: | 1306380696 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILL | ||||||||
| FirstName: | ALEXANDRA | ||||||||
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| Credential: | CSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3304 E. 1-80 SERVICE RD. | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820094711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078297355 | ||||||||
| FaxNumber: | 3074264133 | ||||||||
| Practice Location | |||||||||
| Address1: | 3304 EAST 1-80 SERVICE RD. | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078297355 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2016 | ||||||||
| LastUpdateDate: | 04/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW-267 | WY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.