MEDICARE: MS. SHANNON RUTH SYPERT MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW-1507	WY
2	1041C0700X	Clinical Social Worker	C011672	NC

General Provider Information

NPI Number	:	1679849996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANNON RUTH SYPERT MSW, LCSW

Provider Business Mailing Address
First Line	:	31 E WHITNEY ST
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-4889
Country	:	US
Telephone Number	:	307-674-6995
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 E WHITNEY ST
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-4889
Country	:	US
Telephone Number	:	307-674-6995
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2012
Last Update Date	:	03/17/2026

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