Provider Demographics
NPI:1295155190
Name:MOUNTAIN WEST SPEECH SERVICES LLC
Entity type:Organization
Organization Name:MOUNTAIN WEST SPEECH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:307-399-2876
Mailing Address - Street 1:8957 KOOPER TRL
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7935
Mailing Address - Country:US
Mailing Address - Phone:307-399-2876
Mailing Address - Fax:
Practice Address - Street 1:8957 KOOPER TRL
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7935
Practice Address - Country:US
Practice Address - Phone:307-399-2876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY2014-000660467OtherSTATE FILE NUMBER