Healthcare Provider Details

I. General information

NPI: 1932305281
Provider Name (Legal Business Name): NORTHFORK SPEECH AND HEARING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 GILCHRIST ST
WHEATLAND WY
82201-2932
US

IV. Provider business mailing address

968 GILCHRIST ST
WHEATLAND WY
82201-2932
US

V. Phone/Fax

Practice location:
  • Phone: 307-322-3332
  • Fax: 307-322-3623
Mailing address:
  • Phone: 307-322-3332
  • Fax: 307-322-3623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number168
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateWY
# 4
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number627
License Number StateNE

VIII. Authorized Official

Name: DR. LORI L. ARCHIE
Title or Position: OWNER
Credential: AU.D.
Phone: 307-322-3332