Provider Demographics
NPI:1134291131
Name:BIGGS, GLENN DALE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:DALE
Last Name:BIGGS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 823
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-0823
Mailing Address - Country:US
Mailing Address - Phone:307-324-5899
Mailing Address - Fax:307-324-2659
Practice Address - Street 1:1101 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5211
Practice Address - Country:US
Practice Address - Phone:307-324-5899
Practice Address - Fax:307-324-2695
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW2301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical