Individual
MARYELLEN DEVIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
555 E BROADWAY AVE STE 100, JACKSON, WY 83001-8640
(307) 739-7491
(307) 739-1831
Mailing address
555B CACHE CREEK DR, JACKSON, WY 83001-8653
(716) 997-3566
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP-1405
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SP-1405
SP LICENSE
WY
Enumeration date
07/01/2025
Last updated
07/01/2025
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