Individual
STEPHANIE RENE BOICOURT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10113 BEULAH AVE, CHEYENNE, WY 82009-8960
(307) 287-8724
Mailing address
10113 BEULAH AVE, CHEYENNE, WY 82009-8960
(307) 287-8724
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
107361230
WY
Other
Enumeration date
11/29/2010
Last updated
11/29/2010
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