Christa J Vandervort, SP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP080 Issued in WY

Practice address

1400 Uinta Dr
Green River, WY 82935-5060

Phone

(307) 872-4500

Fax

(307) 872-4595

NPI assigned

Apr 23, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Charles R. Vandervort, O.D., P.C.

  dba Eye Care Specialists of Green River

  • Optometrist
  • Green River, WY
  • NPI 1467697862
  NPD (past)

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208908800000",
    "number": "1215102132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 UINTA DR",
            "city": "GREEN RIVER",
            "state": "WY",
            "postal_code": "829355060",
            "telephone_number": "307-872-4500",
            "fax_number": "307-872-4595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 UINTA DR",
            "city": "GREEN RIVER",
            "state": "WY",
            "postal_code": "829355060",
            "telephone_number": "307-872-4500",
            "fax_number": "307-872-4595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERVORT",
        "first_name": "CHRISTA",
        "middle_name": "J",
        "credential": "SP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-23",
        "last_updated": "2008-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WY",
            "license": "SP080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "080042349",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Malinda Ranee Tollefson, MSW, LCSW
• Tiffanie S Toone, PHARMD
• Mara Trumble
• Tara Vanderpool
• Charles R. Vandervort, O.D.
• Svetlana Wells, PHARM.D
• Elena Wendel, RDN
• Donald C. West, D.D.S.
• Aja Witt
• Wraparound of Sweetwater County

• Speech-Language Pathologist in Green River, WY
• Providers in Green River, WY by specialty
• Speech-Language Pathologist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; 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.