Healthcare Provider Details

I. General information

NPI: 1619889938
Provider Name (Legal Business Name): KELLIE G OLSON-BUDIG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 N KENWOOD ST
CASPER WY
82601-2724
US

IV. Provider business mailing address

3615 COLE CREEK RD
EVANSVILLE WY
82636-9809
US

V. Phone/Fax

Practice location:
  • Phone: 307-267-9292
  • Fax:
Mailing address:
  • Phone: 307-267-9292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number14597400
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: