| Doctor Name: | MS. MICHELE DOLORES DEHERRERA |
| NPI Number: | 1093149965 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CSW |
| License Number: | 221 |
| Business Practice Address: | 1800 Edinburgh Rawlins, WY - 82301 |
| Business Phone Number: | 3073248820 |
| Business Fax Number: | 3073330261 |
| Mailing Address: | 804 W Pine St, RAWLINS |
| State: | WY |
| Postal Code: | 823015434 |
| Phone Number: | 3073213950 |
| Fax Number: | 3073330261 |
| NPI Enumeration Date: | 08/28/2013 |
| NPI Last Update Date: | 08/28/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 221 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |