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General NPI Number Information
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NPI Number | 1629768015
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Entity Type | Organization
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Legal Business Name | SPEECH SPECIALISTS OF NORTHEAST WYOMING LLC
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 2007 S DOUGLAS HWY STE 140
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City | GILLETTE
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State | WY
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Zip | 82718-5400
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Country | US
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Telephone | 307-257-7395
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Fax | 307-316-7244
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Provider Business Mailing Address
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Address Line | 2007 S DOUGLAS HWY STE 140
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City | GILLETTE
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State | WY
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Zip | 82718-5400
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Country | US
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Telephone | 307-257-7395
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Fax | 307-316-7244
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | WENDY LEE ECHOLS
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Credential | M. S. CCC-SLP, IBCLC
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Telephone | 307-257-7395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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