Healthcare Provider Details

I. General information

NPI: 1598913774
Provider Name (Legal Business Name): MARY M STREIB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2008
Last Update Date: 08/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 STAMPEDE ST
NEWCASTLE WY
82701-3037
US

IV. Provider business mailing address

104 STAMPEDE ST
NEWCASTLE WY
82701-3037
US

V. Phone/Fax

Practice location:
  • Phone: 307-746-3541
  • Fax:
Mailing address:
  • Phone: 307-746-3541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-488
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: