Provider Demographics
NPI:1437923174
Name:COSNER, EMILY NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE
Last Name:COSNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 BRETTON DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3146
Mailing Address - Country:US
Mailing Address - Phone:307-258-3629
Mailing Address - Fax:
Practice Address - Street 1:535 W YELLOWSTONE HWY
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-7507
Practice Address - Country:US
Practice Address - Phone:307-265-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY11941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1337556001972851038Medicaid