| Doctor Name: | MS. DORTHY BAKER KISTER |
| NPI Number: | 1790942357 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW |
| License Number: | LCSW #216 |
| Business Practice Address: | 1114 Lane 12 Lovell, WY - 824319555 |
| Business Phone Number: | 3075486543 |
| Business Fax Number: | 3075486565 |
| Mailing Address: | 1114 Lane 12, LOVELL |
| State: | WY |
| Postal Code: | 824319555 |
| Phone Number: | 3075486543 |
| Fax Number: | 3075486565 |
| NPI Enumeration Date: | 05/21/2008 |
| NPI Last Update Date: | 04/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LCSW #216 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |