MEDICARE: SUZY GANER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PPC-951	WY

General Provider Information

NPI Number	:	1336592674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZY GANER

Provider Business Mailing Address
First Line	:	PO BOX 2299
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-2299
Country	:	US
Telephone Number	:	307-690-5398
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 S CACHE ST
Second Line	:	SUITE 14
City	:	JACKSON
State	:	WY
Zip	:	83001-8222
Country	:	US
Telephone Number	:	307-690-5398
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	07/21/2016

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Directions to “ SUZY GANER ” Practice Location

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