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General NPI Number Information
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NPI Number | 1215316062
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Entity Type | Individual
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Provider Name | SKYE EILEEN WYRICK LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 222 E MAIN ST UNIT 1E
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City | ENNIS
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State | MT
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Zip | 59729-9230
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Country | US
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Telephone | 720-295-6758
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Fax |
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Provider Business Mailing Address
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Address Line | 118 HAYFIELD LOOP TRL
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City | ENNIS
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State | MT
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Zip | 59729-9171
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Country | US
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Telephone | 720-296-6758
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 5041
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 09928397
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 70523
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License Number State | MT
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