Organization
EARLY INTERVENTION PROGRAM
Active
Organization
EARLY INTERVENTION PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURENE HINES (ASSISTANT DIRECTOR)
(307) 332-3516
Entity
Organization
Contact information
Practice address
9 SHIPTON LANE, FORT WASHAKIE, WY 82514-0610
(307) 332-3516
(307) 332-9116
Mailing address
PO BOX 610, FORT WASHAKIE, WY 82514-0610
(307) 332-3516
(307) 332-9116
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
129040100
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129040100
—
WY
Enumeration date
03/02/2015
Last updated
04/28/2017
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