Provider Demographics
NPI:1891828752
Name:SINKS CANYON THERAPIES INC
Entity Type:Organization
Organization Name:SINKS CANYON THERAPIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIENLEN-TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:307-332-2715
Mailing Address - Street 1:307 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520
Mailing Address - Country:US
Mailing Address - Phone:307-332-2715
Mailing Address - Fax:
Practice Address - Street 1:307 MAIN ST.
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520
Practice Address - Country:US
Practice Address - Phone:307-332-2715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Not Answered261QA3000XAmbulatory Health Care FacilitiesClinic/CenterAugmentative Communication
Not Answered261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY123118900Medicaid