Provider Demographics
NPI:1588892566
Name:UPDIKE-WYSSMANN, DEANNE (MS, NCC, LPC)
Entity type:Individual
Prefix:
First Name:DEANNE
Middle Name:
Last Name:UPDIKE-WYSSMANN
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6692
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-7103
Mailing Address - Country:US
Mailing Address - Phone:307-751-3263
Mailing Address - Fax:
Practice Address - Street 1:1949 SUGARLAND DR
Practice Address - Street 2:SUITE 218
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5755
Practice Address - Country:US
Practice Address - Phone:307-751-3263
Practice Address - Fax:307-674-1825
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY881101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY134978300Medicaid