Provider Demographics
NPI:1588845424
Name:THOMAS, CHERYL (WRAPAROUND/CM)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:WRAPAROUND/CM
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:REISENAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:921 S 9TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5851
Mailing Address - Country:US
Mailing Address - Phone:701-328-3938
Mailing Address - Fax:
Practice Address - Street 1:921 S 9TH ST STE 110
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5851
Practice Address - Country:US
Practice Address - Phone:701-328-3938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4054104100000X
ND171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker