Provider Demographics
NPI:1366440471
Name:STRAYER, CONNIE KAY (MSW)
Entity Type:Individual
Prefix:MISS
First Name:CONNIE
Middle Name:KAY
Last Name:STRAYER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:CONNIE
Other - Middle Name:KAY
Other - Last Name:STUMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1954 W MARIPOSA PKWY
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-3102
Mailing Address - Country:US
Mailing Address - Phone:307-322-3190
Mailing Address - Fax:
Practice Address - Street 1:1954 W MARIPOSA PKWY
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-3102
Practice Address - Country:US
Practice Address - Phone:307-322-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY741041C0700X
WY09106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY307577OtherBS
307577Medicare ID - Type Unspecified