Provider Demographics
NPI:1679849996
Name:SYPERT, SHANNON RUTH (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:RUTH
Last Name:SYPERT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 W LOTT ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-1642
Mailing Address - Country:US
Mailing Address - Phone:307-684-5531
Mailing Address - Fax:
Practice Address - Street 1:521 W LOTT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1642
Practice Address - Country:US
Practice Address - Phone:307-684-5531
Practice Address - Fax:704-531-9266
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0116721041C0700X
WYLCSW-15071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW26921Medicare UPIN