Provider Demographics
NPI:1053449512
Name:SCHILLING, MARTHA ESTHER (PHD)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ESTHER
Last Name:SCHILLING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4305
Mailing Address - Country:US
Mailing Address - Phone:307-745-8586
Mailing Address - Fax:307-742-9208
Practice Address - Street 1:700 S 18TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4305
Practice Address - Country:US
Practice Address - Phone:307-745-8586
Practice Address - Fax:307-742-9208
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY156103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY305331Medicare ID - Type UnspecifiedBILLING NUMBER