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General NPI Number Information
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NPI Number | 1679815989
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Entity Type | Organization
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Legal Business Name | CHICKEN LIPPS APPS LLC
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Dates
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Enumeration Date | 03/25/2013
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Last Update Date | 03/25/2013
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Provider Practice Location Address
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Address Line | 372 US HIGHWAY 16 E
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City | BUFFALO
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State | WY
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Zip | 82834-9522
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Country | US
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Telephone | 307-620-0054
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Fax | 307-684-5890
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Provider Business Mailing Address
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Address Line | 372 US HIGHWAY 16 E
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City | BUFFALO
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State | WY
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Zip | 82834-9522
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Country | US
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Telephone | 307-620-0054
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Fax | 307-684-5890
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | BEVERLY G KENIK
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Credential | M.A
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Telephone | 307-620-0054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP-318
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License Number State | WY
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