Provider Demographics
NPI:1972604874
Name:WRIEDT-BYRNE, SUSAN L (MS,LPC,NNC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:WRIEDT-BYRNE
Suffix:
Gender:F
Credentials:MS,LPC,NNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 S SPRUCE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1759
Mailing Address - Country:US
Mailing Address - Phone:307-462-1653
Mailing Address - Fax:
Practice Address - Street 1:437 SOUTH SPRUCE STREET
Practice Address - Street 2:SUITE B
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1759
Practice Address - Country:US
Practice Address - Phone:307-462-1653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY010581119OtherTAX ID NUMBER