Healthcare Provider Details

I. General information

NPI: 1164782538
Provider Name (Legal Business Name): CENTRAL WYOMING SPEECH THERAPY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 S CENTER ST
CASPER WY
82601-6415
US

IV. Provider business mailing address

5410 S CENTER ST
CASPER WY
82601-6415
US

V. Phone/Fax

Practice location:
  • Phone: 307-267-5541
  • Fax: 307-235-3985
Mailing address:
  • Phone: 307-267-5541
  • Fax: 307-235-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberSP-310
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-310
License Number StateWY

VIII. Authorized Official

Name: MRS. AMY ELIZABETH LINAM
Title or Position: SPEECH LANGUAGE PATHOLOGIST & PRES.
Credential: MS, CCC-SLP
Phone: 307-267-5541