Most Relevant Information
Provider Data
| NPI Number: | 1003307240 |
| Provider Name: | JACQUELYN RALPH PPC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | PPC-1254 |
Most Important Dates
| Enumeration Date: | 05/23/2018 |
| Last Updated: | 06/06/2021 |
Provider Practice Location
1575 N 4TH ST STE 103
LARAMIE
WY
820722091
Practice Location Phone/Fax
| Phone: | 3077210700 |
| Fax: |
Provider Mailing Location
1575 N 4TH ST STE 103
LARAMIE
WY
820722091
Provider Mailing Phone/Fax
| Phone: | 3077210700 |
| Fax: |