Provider Demographics
NPI:1790398741
Name:SZYMANSKI, DEVIN
Entity Type:Individual
Prefix:MR
First Name:DEVIN
Middle Name:
Last Name:SZYMANSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BARTHOLOMEW WAY
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-8940
Mailing Address - Country:US
Mailing Address - Phone:307-887-9991
Mailing Address - Fax:
Practice Address - Street 1:1202 E JACKSON AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3866
Practice Address - Country:US
Practice Address - Phone:307-856-4337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-1109235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist