Provider Demographics
NPI:1932594231
Name:TRAUNTVEIN, KEIRA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KEIRA
Middle Name:MARIE
Last Name:TRAUNTVEIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KEIRA
Other - Middle Name:MARIE
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1143
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-1143
Mailing Address - Country:US
Mailing Address - Phone:435-671-8227
Mailing Address - Fax:
Practice Address - Street 1:487A N MAIN ST
Practice Address - Street 2:
Practice Address - City:THAYNE
Practice Address - State:WY
Practice Address - Zip Code:83127
Practice Address - Country:US
Practice Address - Phone:307-883-8877
Practice Address - Fax:307-883-8876
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-739235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY139838500Medicaid