Provider Demographics
NPI:1720064686
Name:STRAYER, ROBERT CONRAD (MSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CONRAD
Last Name:STRAYER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 SO 22ND ST.
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070
Mailing Address - Country:US
Mailing Address - Phone:307-742-9809
Mailing Address - Fax:
Practice Address - Street 1:255 N 30TH STREET
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072
Practice Address - Country:US
Practice Address - Phone:307-742-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY0191041C0700X
WY019LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYMH75OtherWINHEALTH PARTNERS
WY307576OtherBS
WY8000014276OtherRR MEDICARE
307576Medicare Oscar/Certification
WY8000014276OtherRR MEDICARE