Individual
KATHLEEN BAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
617 W 26TH ST, CHEYENNE, WY 82001-3010
(307) 286-3689
Mailing address
617 W 26TH ST, CHEYENNE, WY 82001-3010
(307) 286-3689
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689052177
—
WY
Enumeration date
05/15/2015
Last updated
07/31/2015
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