Provider Demographics
NPI:1356850622
Name:ALEXANDER, CATHERINE REBECCA
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:REBECCA
Last Name:ALEXANDER
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 1:625 E MADISON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-4712
Mailing Address - Country:US
Mailing Address - Phone:307-463-0337
Mailing Address - Fax:307-856-8205
Practice Address - Street 1:625 E MADISON AVE STE 1
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4712
Practice Address - Country:US
Practice Address - Phone:307-463-0337
Practice Address - Fax:307-856-8205
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCSW-249104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker