Individual
MRS. NANCY ANN AXTHELM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCCSLP
Contact information
Practice address
808 NORTH STREET, CODY, WY 82414-5213
(307) 527-7060
(307) 587-2497
Mailing address
PO BOX 2901, CODY, WY 82414-5213
(307) 527-7060
(307) 587-2497
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP158
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770688871
—
WY
Enumeration date
08/24/2007
Last updated
08/24/2007
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