Provider Demographics
NPI:1760637813
Name:VERPLANCKE, JODI M
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:M
Last Name:VERPLANCKE
Suffix:
Gender:F
Credentials:
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:307-684-2912
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:307-684-2912
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1386798239Medicaid