Provider Demographics
NPI:1295828366
Name:VASSEN, VIRGINIA S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:S
Last Name:VASSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2701
Mailing Address - Country:US
Mailing Address - Phone:307-674-4405
Mailing Address - Fax:
Practice Address - Street 1:1221 W 5TH SREET
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2701
Practice Address - Country:US
Practice Address - Phone:307-674-4405
Practice Address - Fax:307-673-5167
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND27451041C0700X
WY5671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY21751OtherMEDICARE PTAN
ND54516Medicaid
WY21751OtherMEDICARE PTAN