Individual
MARY ANN FLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1202 E JACKSON AVE, RIVERTON, WY 82501-3866
(307) 856-4337
Mailing address
PO BOX 593, LANDER, WY 82520-0593
(307) 856-4337
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP016
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SP016
SPEECH LICENSE
WY
Enumeration date
05/04/2017
Last updated
05/04/2017
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