Provider Demographics
NPI:1386802577
Name:PITSCH, MADELEINE JEANNE (EDS IN SCHOOL PSYC)
Entity type:Individual
Prefix:MRS
First Name:MADELEINE
Middle Name:JEANNE
Last Name:PITSCH
Suffix:
Gender:F
Credentials:EDS IN SCHOOL PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 DEWAR DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5773
Mailing Address - Country:US
Mailing Address - Phone:307-382-3058
Mailing Address - Fax:
Practice Address - Street 1:2001 DEWAR DR
Practice Address - Street 2:SUITE 270
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5773
Practice Address - Country:US
Practice Address - Phone:307-382-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-25
Last Update Date:2008-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC356101YM0800X
WYCSSP01103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health