Individual
LISA R HENDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW, MA CSW
Contact information
Practice address
604 E 25TH ST, CHEYENNE, WY 82001-3133
(307) 637-3953
(307) 638-6805
Mailing address
604 E 25TH ST, CHEYENNE, WY 82001-3133
(307) 637-3953
(307) 638-6805
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
157
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106079100
—
WY
Enumeration date
04/19/2010
Last updated
03/16/2011
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