Healthcare Provider Details

I. General information

NPI: 1093807281
Provider Name (Legal Business Name): MARY JO PETRAS MA CCCA FAAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 SHERIDAN AVE SUITE 150 BIG HORN BASIN HEARING INC
CODY WY
82414
US

IV. Provider business mailing address

26 TALON DRIVE
CODY WY
82414
US

V. Phone/Fax

Practice location:
  • Phone: 307-527-6475
  • Fax: 307-527-6483
Mailing address:
  • Phone: 307-587-0343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUDIOLOGY A966
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUDIOLOGIST HEARING
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: