Provider Demographics
NPI:1801999826
Name:ALLEY, MICHAEL B (MS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:B
Last Name:ALLEY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3149
Mailing Address - Country:US
Mailing Address - Phone:307-332-5088
Mailing Address - Fax:307-332-2378
Practice Address - Street 1:125 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3149
Practice Address - Country:US
Practice Address - Phone:307-332-5088
Practice Address - Fax:307-332-2378
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA-901231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY9095Medicare PIN