Healthcare Provider Details

I. General information

NPI: 1063695419
Provider Name (Legal Business Name): JAMES WILLIAM WYSSMANN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 SUGARLAND DR STE 218
SHERIDAN WY
82801-5765
US

IV. Provider business mailing address

PO BOX 6692
SHERIDAN WY
82801
US

V. Phone/Fax

Practice location:
  • Phone: 307-752-0677
  • Fax: 307-674-1825
Mailing address:
  • Phone: 307-752-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number403
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: