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General NPI Number Information
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NPI Number | 1841947926
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Entity Type | Organization
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Legal Business Name | CANNON THERAPY
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Dates
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Enumeration Date | 03/08/2022
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 2909 BENT AVE
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City | CHEYENNE
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State | WY
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Zip | 82001-2742
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Country | US
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Telephone | 970-290-9897
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20885
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City | CHEYENNE
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State | WY
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Zip | 82003-7018
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY V STELZNER
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Credential | LCSW
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Telephone | 970-290-9897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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