Healthcare Provider Details

I. General information

NPI: 1073062774
Provider Name (Legal Business Name): KIRSTIN DENNIS SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 HWY 414 NORTH
MOUNTAIN VIEW WY
82939
US

IV. Provider business mailing address

PO BOX 570
MOUNTAIN VIEW WY
82939-0570
US

V. Phone/Fax

Practice location:
  • Phone: 307-782-6601
  • Fax:
Mailing address:
  • Phone: 307-782-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-715
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: