Provider Demographics
NPI:1558801217
Name:KIRBY, ELIYA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIYA
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 WERNER CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1305
Mailing Address - Country:US
Mailing Address - Phone:307-234-9360
Mailing Address - Fax:
Practice Address - Street 1:851 WERNER CT
Practice Address - Street 2:SUITE 100
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1305
Practice Address - Country:US
Practice Address - Phone:307-234-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist