Provider Demographics
NPI:1952772097
Name:WANN, DESIREE LYNN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:LYNN
Last Name:WANN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 SEYMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3159
Mailing Address - Country:US
Mailing Address - Phone:307-634-9653
Mailing Address - Fax:307-638-8256
Practice Address - Street 1:2526 SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3159
Practice Address - Country:US
Practice Address - Phone:307-634-9653
Practice Address - Fax:307-638-8256
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-10931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical