Healthcare Provider Details

I. General information

NPI: 1174646376
Provider Name (Legal Business Name): CHILD DEVELOPMENT CENTER REGION 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 S LINDEN AVE
SHERIDAN WY
82801-4709
US

IV. Provider business mailing address

345 S LINDEN AVE
SHERIDAN WY
82801-4709
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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA ODELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 307-672-6610