Provider Demographics
NPI:1497363766
Name:WADSACK, DARYLENE L (BSW)
Entity Type:Individual
Prefix:MRS
First Name:DARYLENE
Middle Name:L
Last Name:WADSACK
Suffix:
Gender:F
Credentials:BSW
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 3011
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-3011
Mailing Address - Country:US
Mailing Address - Phone:307-688-5086
Mailing Address - Fax:
Practice Address - Street 1:501 BURMA AVE.
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-8271
Practice Address - Country:US
Practice Address - Phone:307-688-5086
Practice Address - Fax:307-688-5015
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker