Provider Demographics
NPI:1871589317
Name:STERNITZKE, MARY ELLEN (PHD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:STERNITZKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 W PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-2537
Mailing Address - Country:US
Mailing Address - Phone:307-638-4625
Mailing Address - Fax:307-635-3965
Practice Address - Street 1:821 W PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2537
Practice Address - Country:US
Practice Address - Phone:307-638-4625
Practice Address - Fax:307-635-3965
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY267103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW9205Medicare ID - Type Unspecified