Provider Demographics
NPI:1770858342
Name:FALKNER-WANN, MINDY K (MA)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:K
Last Name:FALKNER-WANN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5256
Mailing Address - Country:US
Mailing Address - Phone:307-632-6433
Mailing Address - Fax:307-635-7982
Practice Address - Street 1:2310 E 8TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5256
Practice Address - Country:US
Practice Address - Phone:307-632-6433
Practice Address - Fax:307-635-7982
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY252106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist