=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891828752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SINKS CANYON THERAPIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 307 MAIN ST.
-----------------------------------------------------
City | LANDER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-332-2715
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 307 MAIN ST.
-----------------------------------------------------
City | LANDER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-332-2715
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER-SPEECH-LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MS. KYLE KIENLEN-TRUJILLO
-----------------------------------------------------
Credential | M.S., CCC-SLP
-----------------------------------------------------
Telephone | 307-332-2715
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA3000X
-----------------------------------------------------
Taxonomy Name | Augmentative Communication Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------