Active NPI
Susan Blake Amory, CSW, LPC
- Professional Counselor
- Cheyenne, WY
National Provider Identifier
1679975635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 1725
- Practice address
- 300 E 17TH St
Cheyenne, WY 82001 - Phone
- (307) 631-9931
- Fax
- (307) 635-7706
- NPI assigned
- Sep 22, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 235 | WY | |
| Professional Counselor | 101YP2500X | 1725 | WY | Primary |
Addresses
Primary practice location
300 E 17TH St
Cheyenne, WY 82001
Mailing address
1914 Thomes Ave
Cheyenne, WY 82001-3527
Phone (307) 631-9931
Other names 1
- Susan Blake Prendergrast
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 235 | WY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hansen & Associates Inc | Professional | Past | Accepting new patients |
| Hansen and Associates | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Cheyenne, WY
- NPI 1255702072
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532995200000",
"number": "1679975635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1914 THOMES AVE",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820013527",
"telephone_number": "307-631-9931",
"fax_number": "307-635-7706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 E 17TH ST",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "82001",
"telephone_number": "307-631-9931",
"fax_number": "307-635-7706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AMORY",
"first_name": "SUSAN",
"middle_name": "BLAKE",
"credential": "CSW, LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-22",
"last_updated": "2018-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WY",
"license": "235",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WY",
"license": "1725",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SUSAN",
"last_name": "PRENDERGRAST",
"middle_name": "BLAKE",
"credential": "CSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Cheyenne, WY
- American Medical Associates, Inc
- American Medical Response Ambulance Service Inc
- American Medical Response Ambulance Service Inc
- Americare Orthopedics Medical LLC
- Americas Express Urgent Care, LLC
- Amy P Tortorich PC
- Anapath Diagnostics Inc
- Anapath Diagnostics, Inc
- Tina Lynn Andera, FNP/MSN
- Christina S Andersen, OTR/L
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.