Healthcare Provider Details

I. General information

NPI: 1306896402
Provider Name (Legal Business Name): JAN SCHAAD LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2622 PIONEER AVE
CHEYENNE WY
82001-3024
US

IV. Provider business mailing address

PO BOX 326
CHEYENNE WY
82003-0326
US

V. Phone/Fax

Practice location:
  • Phone: 307-630-4688
  • Fax: 307-637-2899
Mailing address:
  • Phone: 307-763-0468
  • Fax: 307-637-2899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number410
License Number StateWY

VIII. Authorized Official

Name: JANICE A SCHAAD
Title or Position: PRESIDENT
Credential: MSW LCSW
Phone: 307-630-4688