Healthcare Provider Details

I. General information

NPI: 1508052705
Provider Name (Legal Business Name): HIGH COUNTRY AUDIOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MAIN ST
LANDER WY
82520-3149
US

IV. Provider business mailing address

125 MAIN ST
LANDER WY
82520-3149
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-5088
  • Fax: 307-332-2378
Mailing address:
  • Phone: 307-332-5088
  • Fax: 307-332-2378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-901
License Number StateWY

VIII. Authorized Official

Name: MR. MICHAEL B. ALLEY
Title or Position: AUDIOLOGIST
Credential: M.S.
Phone: 307-332-5088