Individual
WILLA J TRAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10808 WIND DANCER RD, CHEYENNE, WY 82009
(307) 514-3679
Mailing address
PO BOX 1021, CHEYENNE, WY 82003-1021
(307) 514-3679
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568655827
—
WY
Enumeration date
08/21/2007
Last updated
05/14/2018
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