Provider Demographics
NPI:1164744777
Name:BRUGGER, ANGELA MICHELE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MICHELE
Last Name:BRUGGER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 E LOUCKS ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6339
Mailing Address - Country:US
Mailing Address - Phone:307-675-1805
Mailing Address - Fax:
Practice Address - Street 1:45 E LOUCKS ST
Practice Address - Street 2:SUITE 112
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6339
Practice Address - Country:US
Practice Address - Phone:307-675-1805
Practice Address - Fax:307-675-1805
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY408OtherSTATE LICENSURE