1437133089 NPI number — MRS. BILLIE S WORTHAM MS, CCC-A

Table of content: MRS. BILLIE S WORTHAM MS, CCC-A (NPI 1437133089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437133089 NPI number — MRS. BILLIE S WORTHAM MS, CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WORTHAM
Provider First Name:
BILLIE
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437133089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 429
Provider Second Line Business Mailing Address:
106 S MAIN
Provider Business Mailing Address City Name:
LYMAN
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82937-0429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-787-6123
Provider Business Mailing Address Fax Number:
307-787-3351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 S MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYMAN
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-787-6123
Provider Business Practice Location Address Fax Number:
307-787-3351
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  A933 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01025866 . This is a "SPECIALITY LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 104250500 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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