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Provider Information for 1669857801


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BROOKE BODAR


Sex: Female

NPI: 1669857801
Last Updated: 2018-03-07
Certification Date:

Details

NameValue
NPI1669857801
Enumeration Date2015-07-29
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 1800 EDINBURGH ST
RAWLINS, WY 82301-4506
United States

Phone: 307-324-8820 | Fax:307-333-0261
 
Primary Practice Address 4989 N 3RD ST
LARAMIE, WY 82072-9548
United States

Phone: 307-745-8997 | Fax:307-742-6146
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 172V00000X - Community Health Worker
Yes 101YP2500X - Counselor - ProfessionalWY