Individual
CHRISTA J VANDERVORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SP
Contact information
Practice address
1400 UINTA DR, GREEN RIVER, WY 82935-5060
(307) 872-4500
(307) 872-4595
Mailing address
1400 UINTA DR, GREEN RIVER, WY 82935-5060
(307) 872-4500
(307) 872-4595
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP080
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080042349
RAILROAD MEDICARE PIN
WY
Enumeration date
04/23/2008
Last updated
04/23/2008
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