Provider Demographics
NPI:1740636901
Name:STEPHANIE NEUMAN
Entity type:Organization
Organization Name:STEPHANIE NEUMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-760-8004
Mailing Address - Street 1:1705 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5027
Mailing Address - Country:US
Mailing Address - Phone:307-760-8004
Mailing Address - Fax:307-638-4809
Practice Address - Street 1:1705 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5027
Practice Address - Country:US
Practice Address - Phone:307-760-8004
Practice Address - Fax:307-638-4809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY133536700Medicaid