Provider Demographics
NPI:1740906619
Name:PROBERT, VANESSA RENEE (LCSW)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:RENEE
Last Name:PROBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 NAVAJO CIR
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-4518
Mailing Address - Country:US
Mailing Address - Phone:307-677-2735
Mailing Address - Fax:
Practice Address - Street 1:849 FRONT ST STE 103
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3475
Practice Address - Country:US
Practice Address - Phone:307-363-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-10571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical