Active NPI
Mary Ann Flom
- Speech-Language Pathologist
- Riverton, WY
National Provider Identifier
1104352574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP016
- Practice address
- 1202 E Jackson Ave
Riverton, WY 82501-3866 - Phone
- (307) 856-4337
- NPI assigned
- May 4, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP016 | WY | Primary |
Addresses
Primary practice location
1202 E Jackson Ave
Riverton, WY 82501-3866
Mailing address
PO Box 593
Lander, WY 82520-0593
Phone (307) 856-4337
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SP016 | Other | WY | SPEECH LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP016 | WY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493856000000",
"number": "1104352574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 593",
"city": "LANDER",
"state": "WY",
"postal_code": "825200593",
"telephone_number": "307-856-4337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1202 E JACKSON AVE",
"city": "RIVERTON",
"state": "WY",
"postal_code": "825013866",
"telephone_number": "307-856-4337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLOM",
"first_name": "MARY ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-04",
"last_updated": "2017-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WY",
"license": "SP016",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPEECH LICENSE",
"identifier": "SP016",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Riverton, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.