Provider Demographics
NPI:1336318823
Name:TOLLEFSON, MALINDA RANEE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MALINDA
Middle Name:RANEE
Last Name:TOLLEFSON
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 1:440 IOWA AVENUE
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-5610
Mailing Address - Country:US
Mailing Address - Phone:307-871-9415
Mailing Address - Fax:
Practice Address - Street 1:50 SHOSHONE AVE
Practice Address - Street 2:STE B
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-5327
Practice Address - Country:US
Practice Address - Phone:307-871-9415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-6821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical