Healthcare Provider Details

I. General information

NPI: 1932014230
Provider Name (Legal Business Name): STICKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

953 N MCCUE ST LOT 229
LARAMIE WY
82072-6720
US

IV. Provider business mailing address

2201 S 15TH ST LOT 10
LARAMIE WY
82070-5477
US

V. Phone/Fax

Practice location:
  • Phone: 307-761-0684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: KEVIN CONTOS
Title or Position: OFFICER
Credential:
Phone: 307-761-0684