Healthcare Provider Details

I. General information

NPI: 1912826843
Provider Name (Legal Business Name): ASHTYN ANDRA HARMSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 E BRUNDAGE ST
SHERIDAN WY
82801-4345
US

IV. Provider business mailing address

366 E BRUNDAGE ST
SHERIDAN WY
82801-4345
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-6610
  • Fax: 307-674-5947
Mailing address:
  • Phone: 307-672-6610
  • Fax: 307-674-5947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-1503
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: