Organization
NORTHERN DDSP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN N COOK (OWNER/PRESIDENT)
(307) 254-2321
Entity
Organization
Contact information
Practice address
2044 STAMPEDE AVE, CODY, WY 82414-4917
(307) 587-3571
(307) 587-4897
Mailing address
PO BOX 966, CODY, WY 82414-0966
(307) 587-3571
(307) 587-4897
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
116949100
WY
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116949100
—
WY
Enumeration date
01/23/2007
Last updated
11/16/2015
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