Provider Demographics
NPI:1619780624
Name:SWANEY, JENNIFER (CRC, PPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SWANEY
Suffix:
Gender:F
Credentials:CRC, PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 FLEMING BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-9157
Mailing Address - Country:US
Mailing Address - Phone:307-752-6331
Mailing Address - Fax:
Practice Address - Street 1:1949 SUGARLAND DR STE 122
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5763
Practice Address - Country:US
Practice Address - Phone:307-752-9712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1507101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health