Provider Demographics
NPI:1629704820
Name:ANDREEN, CILEY T
Entity Type:Individual
Prefix:
First Name:CILEY
Middle Name:T
Last Name:ANDREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CEDAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THERMOPOLIS
Mailing Address - State:WY
Mailing Address - Zip Code:82443-3109
Mailing Address - Country:US
Mailing Address - Phone:307-921-1880
Mailing Address - Fax:
Practice Address - Street 1:104 CEDAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443-3109
Practice Address - Country:US
Practice Address - Phone:307-921-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health