Provider Demographics
NPI:1386258879
Name:LOESSBERG, AMANDA LENORE (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LENORE
Last Name:LOESSBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3658
Mailing Address - Country:US
Mailing Address - Phone:307-763-2815
Mailing Address - Fax:
Practice Address - Street 1:201 E 5TH ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3658
Practice Address - Country:US
Practice Address - Phone:307-763-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-600361041C0700X
WY12831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical