Provider Demographics
NPI:1235573973
Name:STAEBEN, KATEY R (AUD)
Entity Type:Individual
Prefix:DR
First Name:KATEY
Middle Name:R
Last Name:STAEBEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 HOUSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-2860
Mailing Address - Country:US
Mailing Address - Phone:307-771-2148
Mailing Address - Fax:
Practice Address - Street 1:2810 HOUSE AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2860
Practice Address - Country:US
Practice Address - Phone:307-771-2148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA-995231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist