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General NPI Number Information
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NPI Number | 1033002423
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Entity Type | Individual
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Provider Name | VANESSA STAKES PPC
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Gender | Female
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 502 S 4TH ST
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City | LARAMIE
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State | WY
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Zip | 82070-3704
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Country | US
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Telephone | 307-755-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 502 S 4TH ST
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City | LARAMIE
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State | WY
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Zip | 82070-3704
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Country | US
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Telephone | 303-257-5688
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1553
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License Number State | WY
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