Provider Demographics
NPI:1952060568
Name:HEHR, BRANDEN
Entity Type:Individual
Prefix:MR
First Name:BRANDEN
Middle Name:
Last Name:HEHR
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 1:2334 MCCANN AVE LOT 45
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5963
Mailing Address - Country:US
Mailing Address - Phone:307-369-9974
Mailing Address - Fax:307-369-4558
Practice Address - Street 1:2334 MCCANN AVE LOT 45
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5963
Practice Address - Country:US
Practice Address - Phone:307-369-9974
Practice Address - Fax:307-369-4558
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY207906200Medicaid