Healthcare Provider Details

I. General information

NPI: 1083803761
Provider Name (Legal Business Name): WIND RIVER HEARING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 GARFIELD ST
LANDER WY
82520-3121
US

IV. Provider business mailing address

269 GARFIELD ST
LANDER WY
82520-3121
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-0284
  • Fax: 307-332-6334
Mailing address:
  • Phone: 307-332-0284
  • Fax: 307-332-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberA964
License Number StateWY

VIII. Authorized Official

Name: CELESTA CARTRITE KOMRS
Title or Position: AUDIOLOGIST
Credential: M.S.,CCC/A
Phone: 307-332-0284