Provider Demographics
NPI:1629768015
Name:SPEECH SPECIALISTS OF NORTHEAST WYOMING
Entity Type:Organization
Organization Name:SPEECH SPECIALISTS OF NORTHEAST WYOMING
Other - Org Name:SPEECH SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ECHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:M S CCC-SLP, IBCLC
Authorized Official - Phone:307-257-7395
Mailing Address - Street 1:101 VILLA WAY
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-2800
Mailing Address - Country:US
Mailing Address - Phone:907-201-7854
Mailing Address - Fax:
Practice Address - Street 1:101 VILLA WAY
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-2800
Practice Address - Country:US
Practice Address - Phone:907-201-7854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty