Early Intervention Program

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

EARLY INTERVENTION PROGRAM

Practice address

90 Ethete Road
Fort Washakie, WY 82514

Phone

(307) 332-3516

Fax

(307) 332-9116

NPI assigned

Oct 23, 2009

Last updated

Oct 23, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Sue Jezek, SLP

Title

Director

Phone

(307) 332-3516

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256256000000",
    "number": "1104152388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 610",
            "city": "FORT WASHAKIE",
            "state": "WY",
            "postal_code": "825140610",
            "telephone_number": "307-332-3516",
            "fax_number": "307-332-9116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 ETHETE ROAD",
            "city": "FORT WASHAKIE",
            "state": "WY",
            "postal_code": "82514",
            "telephone_number": "307-332-3516",
            "fax_number": "307-332-9116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EARLY INTERVENTION PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-23",
        "last_updated": "2009-10-23",
        "status": "A",
        "authorized_official_last_name": "JEZEK",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "307-332-3516",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "SLP"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Ann Daverin, RDH
• Jolynn Renee Davis, R.N.
• Dehning Jo Dehning, MS, PT
• Doya Natsu Healing Center- Eastern Shoshone Tribe
• Susan J Duncan, LCSW
• Early Intervention Program
• Early Intervention Program
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• Eastern Shoshone Tribe
• Jill Renee Erickson, RDH

• Developmentally Disabled Services Day Training Agency in Fort Washakie, WY
• Providers in Fort Washakie, WY by specialty
• Developmentally Disabled Services Day Training Agency in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.