Provider Demographics
NPI:1508014382
Name:CRIST, DEBBIE LEE (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:LEE
Last Name:CRIST
Suffix:
Gender:F
Credentials:MS CCCSLP
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 882
Mailing Address - Street 2:115 SOUTH 4TH ST
Mailing Address - City:BASIN
Mailing Address - State:WY
Mailing Address - Zip Code:82410
Mailing Address - Country:US
Mailing Address - Phone:307-568-2914
Mailing Address - Fax:307-568-2914
Practice Address - Street 1:115 SOUTH 4TH ST
Practice Address - Street 2:
Practice Address - City:BASIN
Practice Address - State:WY
Practice Address - Zip Code:82410
Practice Address - Country:US
Practice Address - Phone:307-568-2914
Practice Address - Fax:307-568-2914
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1770688871Medicaid