Active NPI
Randall Wade Mann, M.S. CCC-SLP
- Speech-Language Pathologist
- Cody, WY
National Provider Identifier
1508555350
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP-967
- Practice address
- 3785 Horizon Ave
Cody, WY 82414-9728 - Phone
- (307) 752-2175
- NPI assigned
- May 5, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 | SP-967 | WY | Primary |
Addresses
Primary practice location
3785 Horizon Ave
Cody, WY 82414-9728
Mailing address
3785 Horizon Ave
Cody, WY 82414-9728
Phone (307) 752-2175
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP-967 | WY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683244800000",
"number": "1508555350",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3785 HORIZON AVE",
"city": "CODY",
"state": "WY",
"postal_code": "824149728",
"telephone_number": "307-752-2175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3785 HORIZON AVE",
"city": "CODY",
"state": "WY",
"postal_code": "824149728",
"telephone_number": "307-752-2175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANN",
"first_name": "RANDALL",
"middle_name": "WADE",
"credential": "M.S. CCC-SLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-05-05",
"last_updated": "2023-05-05",
"certification_date": "2023-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WY",
"license": "SP-967",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cody, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.