Provider Demographics
NPI:1750678140
Name:DOUCET, DON (HIS)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:
Last Name:DOUCET
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PATRIOT DR
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-8123
Mailing Address - Country:US
Mailing Address - Phone:307-213-0159
Mailing Address - Fax:307-460-7356
Practice Address - Street 1:443 W COULTER AVE UNIT 6
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2643
Practice Address - Country:US
Practice Address - Phone:307-254-9633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE768237700000X
WY192237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025948900Medicaid
WY81-0957062OtherEIN