Healthcare Provider Details

I. General information

NPI: 1871550541
Provider Name (Legal Business Name): JAN S PIERSON MS, CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 COLE SHOPPING CTR
CHEYENNE WY
82001-5370
US

IV. Provider business mailing address

PO BOX 2417
CHEYENNE WY
82003-2417
US

V. Phone/Fax

Practice location:
  • Phone: 307-432-9601
  • Fax: 307-432-0411
Mailing address:
  • Phone: 307-638-0300
  • Fax: 307-638-0394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number927
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: