Provider Demographics
NPI:1184756272
Name:CODALLOS, KYM FRANCES (MSW,ACSW,LCSW,CPRP)
Entity type:Individual
Prefix:
First Name:KYM
Middle Name:FRANCES
Last Name:CODALLOS
Suffix:
Gender:F
Credentials:MSW,ACSW,LCSW,CPRP
Other - Prefix:
Other - First Name:KYM
Other - Middle Name:FRANCES
Other - Last Name:BAKER-CODALLOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW,ACSW,LCSW
Mailing Address - Street 1:PO BOX 1733
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82073-1733
Mailing Address - Country:US
Mailing Address - Phone:209-247-3686
Mailing Address - Fax:
Practice Address - Street 1:615 ROGER CANYON RD
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-8902
Practice Address - Country:US
Practice Address - Phone:209-247-3686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical