Doctor Name: | MRS. NANCY ANN AXTHELM |
NPI Number: | 1104019850 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CCCSLP |
License Number: | SP158 |
Business Practice Address: | 808 North Street Cody, WY - 824145213 |
Business Phone Number: | 3075277060 |
Business Fax Number: | 3075872497 |
Mailing Address: | Po Box 2901, CODY |
State: | WY |
Postal Code: | 824145213 |
Phone Number: | 3075277060 |
Fax Number: | 3075872497 |
NPI Enumeration Date: | 08/24/2007 |
NPI Last Update Date: | 08/24/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SP158 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |