Provider Demographics
NPI:1457557159
Name:RANEY, JEANNE MARIE (MA CCCSLP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:RANEY
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 E GREEN RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:WY
Mailing Address - Zip Code:82941
Mailing Address - Country:US
Mailing Address - Phone:307-367-2012
Mailing Address - Fax:
Practice Address - Street 1:317 N FALER AVE
Practice Address - Street 2:PROACTIVE PHYSICAL THERAPY PC
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941
Practice Address - Country:US
Practice Address - Phone:307-367-6236
Practice Address - Fax:307-367-3332
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY312061OtherBLUE CROSS BLUE SHIELD