Provider Demographics
NPI:1831758275
Name:LEDERER, DEANNE (LPC)
Entity type:Individual
Prefix:
First Name:DEANNE
Middle Name:
Last Name:LEDERER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 COFFEEN AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5771
Mailing Address - Country:US
Mailing Address - Phone:307-429-2044
Mailing Address - Fax:
Practice Address - Street 1:2161 COFFEEN AVE STE 402
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5771
Practice Address - Country:US
Practice Address - Phone:307-429-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-2016101YP2500X
WYPPC-1119101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYLPC-2016OtherWY MENTAL HEALTH PROFESSIONALS LICENSING BOARD