Provider Demographics
NPI:1184760993
Name:UNIVERSITY OF WYOMING
Entity type:Organization
Organization Name:UNIVERSITY OF WYOMING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOMFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-777-7911
Mailing Address - Street 1:1000 E UNIVERSITY AVE
Mailing Address - Street 2:UNIVERSITY OF WYOMING, DEPT. 3311
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82071-2000
Mailing Address - Country:US
Mailing Address - Phone:307-766-6426
Mailing Address - Fax:307-766-6829
Practice Address - Street 1:1000 E UNIVERSITY AVE
Practice Address - Street 2:UNIVERSITY OF WYOMING, DEPT. 3311
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82071-2000
Practice Address - Country:US
Practice Address - Phone:307-766-6426
Practice Address - Fax:307-766-6829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA971231H00000X
WYA947231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty