Provider Demographics
NPI:1639697535
Name:ACKERMAN, JAYME R (MS, LPC)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:R
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:JAYME
Other - Middle Name:R
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3322 STRAHAN PKWY
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-9162
Mailing Address - Country:US
Mailing Address - Phone:307-672-2044
Mailing Address - Fax:
Practice Address - Street 1:3322 STRAHAN PKWY
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-9162
Practice Address - Country:US
Practice Address - Phone:307-672-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-2112101Y00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator