Provider Demographics
NPI:1982990024
Name:GARD, NICOLE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GARD
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:GARD
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:121 N 5TH ST W
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3453
Mailing Address - Country:US
Mailing Address - Phone:307-856-9407
Mailing Address - Fax:
Practice Address - Street 1:2001 W SUNSET DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2256
Practice Address - Country:US
Practice Address - Phone:307-856-9491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCFY-1241235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist