Healthcare Provider Details

I. General information

NPI: 1538849104
Provider Name (Legal Business Name): ABBY BRUNSKI TANNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N FALER AVENUE
PINEDALE WY
82941
US

IV. Provider business mailing address

PO BOX 862
PINEDALE WY
82941-0862
US

V. Phone/Fax

Practice location:
  • Phone: 307-367-6236
  • Fax:
Mailing address:
  • Phone: 307-723-8118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1285
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: