Healthcare Provider Details

I. General information

NPI: 1174856132
Provider Name (Legal Business Name): MOUNTAIN VIEW AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S FENWAY ST SUITE 203
CASPER WY
82601-3051
US

IV. Provider business mailing address

301 S FENWAY ST SUITE 203
CASPER WY
82601-3051
US

V. Phone/Fax

Practice location:
  • Phone: 307-266-4100
  • Fax: 307-266-4106
Mailing address:
  • Phone: 307-266-4100
  • Fax: 307-266-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberA-928
License Number StateWY

VIII. Authorized Official

Name: DR. KERRI SHANNON MCDILL
Title or Position: PRESIDENT
Credential: AU.D. CCC-A
Phone: 307-266-4100