=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093807281
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY JO PETRAS MA CCCA FAAA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 721 SHERIDAN AVE SUITE 150 BIG HORN BASIN HEARING INC
-----------------------------------------------------
City | CODY
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-527-6475
-----------------------------------------------------
Fax | 307-527-6483
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 TALON DRIVE
-----------------------------------------------------
City | CODY
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-587-0343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AUDIOLOGY A966
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | AUDIOLOGIST HEARING
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------