Provider Demographics
NPI:1629301437
Name:HUGHES, CATHIE L (MA, MCJ)
Entity Type:Individual
Prefix:
First Name:CATHIE
Middle Name:L
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MA, MCJ
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 189
Mailing Address - Street 2:400 B WIND RIVER DRIVE
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-0189
Mailing Address - Country:US
Mailing Address - Phone:307-871-4569
Mailing Address - Fax:
Practice Address - Street 1:280 MONROE AVE
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-5129
Practice Address - Country:US
Practice Address - Phone:307-875-2196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services