Provider Demographics
NPI:1275032054
Name:SLOAN, PETER D (PCSW)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:D
Last Name:SLOAN
Suffix:
Gender:M
Credentials:PCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1194 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2278
Mailing Address - Country:US
Mailing Address - Phone:307-764-2349
Mailing Address - Fax:
Practice Address - Street 1:145 N BENT ST STE 1A
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2711
Practice Address - Country:US
Practice Address - Phone:307-764-2349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-7711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical