Provider Demographics
NPI:1306906581
Name:HODGDON, C. SONNY JR (MSW, LCSW, LAT)
Entity type:Individual
Prefix:MR
First Name:C. SONNY
Middle Name:
Last Name:HODGDON
Suffix:JR
Gender:M
Credentials:MSW, LCSW, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901
Mailing Address - Country:US
Mailing Address - Phone:307-352-6677
Mailing Address - Fax:307-352-6614
Practice Address - Street 1:2300 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901
Practice Address - Country:US
Practice Address - Phone:307-352-6677
Practice Address - Fax:307-352-6614
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLAT-160101YA0400X
WYLCSW-5431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)