Provider Demographics
NPI:1306896402
Name:JAN SCHAAD LCSW PC
Entity type:Organization
Organization Name:JAN SCHAAD LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHAAD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:307-630-4688
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-0326
Mailing Address - Country:US
Mailing Address - Phone:307-763-0468
Mailing Address - Fax:307-637-2899
Practice Address - Street 1:2622 PIONEER AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3024
Practice Address - Country:US
Practice Address - Phone:307-630-4688
Practice Address - Fax:307-637-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW21033OtherMEDICARE PROVIDER TRANSACTION NUMBER
WY123007700Medicaid
WYP00368425OtherMEDICARE RAILROAD