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General NPI Number Information
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NPI Number | 1497115471
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Entity Type | Individual
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Provider Name | ANDREA SCHUCK MSW, PCSW
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Gender | Female
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 4509 FOOTHILL BLVD
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-4367
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Country | US
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Telephone | 307-352-6871
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Fax | 307-352-6873
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Provider Business Mailing Address
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Address Line | 4509 FOOTHILL BLVD
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-4367
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Country | US
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Telephone | 307-352-6871
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Fax | 307-352-6873
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | PCSW-604
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License Number State | WY
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