# WYOMING WIC PROGRAM

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366634396
- **Authorized official:** JEAN A BOULEY (ADMINISTRATIVE SPECIALIST 3)
- **Authorized official phone:** (307) 777-7494

## Contact information

- **Practice address:** 6101 YELLOWSTONE ROAD, SUITE 510, CHEYENNE, WY 82002-0001
- **Practice address phone:** (307) 777-7494
- **Practice address fax:** (307) 777-5643
- **Mailing address:** 6101 YELLOWSTONE ROAD, SUITE 510, CHEYENNE, WY 82002-0001
- **Mailing address phone:** (307) 777-7494
- **Mailing address fax:** (307) 777-5643

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251K00000X | Public Health or Welfare Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 08/14/2007
- **Last updated:** 07/07/2008