Provider Demographics
NPI:1417005430
Name:KREITZMANN, CHERI MARIE (MS, LPC)
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:MARIE
Last Name:KREITZMANN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TAPADERO LN
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9622
Mailing Address - Country:US
Mailing Address - Phone:307-250-1338
Mailing Address - Fax:
Practice Address - Street 1:14 TAPADERO LN
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414
Practice Address - Country:US
Practice Address - Phone:307-250-1338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1531101YP2500X
WI2234-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY133205802Medicaid
WI42234700Medicaid