Healthcare Provider Details

I. General information

NPI: 1497115471
Provider Name (Legal Business Name): ANDREA SCHUCK MSW, PCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 FOOTHILL BLVD
ROCK SPRINGS WY
82901-4367
US

IV. Provider business mailing address

4509 FOOTHILL BLVD
ROCK SPRINGS WY
82901-4367
US

V. Phone/Fax

Practice location:
  • Phone: 307-352-6871
  • Fax: 307-352-6873
Mailing address:
  • Phone: 307-352-6871
  • Fax: 307-352-6873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberPCSW-604
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: