Provider Demographics
NPI:1679294128
Name:COLEHOUR, JESSICA SHERI ANNA LOUISE (PCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SHERI ANNA LOUISE
Last Name:COLEHOUR
Suffix:
Gender:F
Credentials:PCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 DELL RANGE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-5273
Mailing Address - Country:US
Mailing Address - Phone:307-630-4729
Mailing Address - Fax:
Practice Address - Street 1:2500 DELL RANGE BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-5273
Practice Address - Country:US
Practice Address - Phone:307-630-4729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-10151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical