Provider Demographics
NPI:1285756189
Name:SUCHER, ELLA LOUISE
Entity type:Individual
Prefix:MRS
First Name:ELLA
Middle Name:LOUISE
Last Name:SUCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 HERRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3644
Mailing Address - Country:US
Mailing Address - Phone:307-472-1812
Mailing Address - Fax:
Practice Address - Street 1:3117 HERRINGTON DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3644
Practice Address - Country:US
Practice Address - Phone:307-472-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY0600301404Medicaid