Individual
MRS. ALEXIS THEONI BELLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
5801 YELLOWSTONE RD, CHEYENNE, WY 82009-4174
(307) 638-6100
Mailing address
935 NEW BEDFORD DR, CHEYENNE, WY 82009-2810
(307) 631-0052
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP-538
WY
Other
Enumeration date
09/20/2013
Last updated
09/20/2013
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