Provider Demographics
NPI:1033645825
Name:LASDEN, JAMIE R
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:R
Last Name:LASDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12703
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-2703
Mailing Address - Country:US
Mailing Address - Phone:781-254-0304
Mailing Address - Fax:
Practice Address - Street 1:690 S USHWY 89
Practice Address - Street 2:SUITE 201
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-2703
Practice Address - Country:US
Practice Address - Phone:781-254-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID433681041C0700X
WY12001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical