Provider Demographics
NPI:1366989428
Name:SCHEIDEMANTEL, SUSANNE
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:SCHEIDEMANTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSANNE
Other - Middle Name:
Other - Last Name:SCHEIDEMANTEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:150 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-2846
Mailing Address - Country:US
Mailing Address - Phone:307-335-5188
Mailing Address - Fax:307-333-0600
Practice Address - Street 1:150 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-2846
Practice Address - Country:US
Practice Address - Phone:307-335-5188
Practice Address - Fax:307-333-0600
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY0458405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional