Individual
JANELL TABBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1801 S 4J RD, GILLETTE, WY 82718-5201
(307) 682-2392
Mailing address
1801 S 4J RD, GILLETTE, WY 82718-5201
(307) 682-2392
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP-815
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SP-815
STATE OF WYOMING
WY
Enumeration date
02/03/2017
Last updated
02/03/2017
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