Provider Demographics
NPI:1154580140
Name:FITZGERALD, ANNE CATHERINE (PHD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:CATHERINE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:CATHERINE
Other - Last Name:BUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1465 N 4TH ST STE 113
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2066
Mailing Address - Country:US
Mailing Address - Phone:307-399-7499
Mailing Address - Fax:
Practice Address - Street 1:1465 N 4TH ST STE 113
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2066
Practice Address - Country:US
Practice Address - Phone:307-399-7499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY136294100Medicaid