Provider Demographics
NPI:1437133089
Name:WORTHAM, BILLIE S (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:BILLIE
Middle Name:S
Last Name:WORTHAM
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:106 S MAIN
Mailing Address - City:LYMAN
Mailing Address - State:WY
Mailing Address - Zip Code:82937-0429
Mailing Address - Country:US
Mailing Address - Phone:307-787-6123
Mailing Address - Fax:307-787-3351
Practice Address - Street 1:106 S MAIN
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:WY
Practice Address - Zip Code:82937
Practice Address - Country:US
Practice Address - Phone:307-787-6123
Practice Address - Fax:307-787-3351
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA933231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01025866OtherSPECIALITY LICENSE
WY104250500Medicaid
01025866OtherSPECIALITY LICENSE