Provider Demographics
NPI:1831719418
Name:CRAYTON, STEPHEN R
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:CRAYTON
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 1:1950 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2506
Mailing Address - Country:US
Mailing Address - Phone:307-655-5755
Mailing Address - Fax:
Practice Address - Street 1:1950 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2506
Practice Address - Country:US
Practice Address - Phone:307-655-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator