Provider Demographics
NPI:1013517689
Name:DZEMSKE, LEANN M (M SC, LPC, ATR)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:M
Last Name:DZEMSKE
Suffix:
Gender:F
Credentials:M SC, LPC, ATR
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 11625
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-1625
Mailing Address - Country:US
Mailing Address - Phone:307-231-2001
Mailing Address - Fax:307-288-6056
Practice Address - Street 1:690 S HWY 89 # 201
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8508
Practice Address - Country:US
Practice Address - Phone:307-231-2001
Practice Address - Fax:307-288-6056
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-9991101YM0800X
221700000X
WYLPC-2182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist