| Develpmental Pediatric Services | |
|
915 S David St Casper WY 82601-3737 | |
| (307) 472-3769 | |
| (307) 472-3607 |
| Full Name | Develpmental Pediatric Services |
|---|---|
| Speciality | Counselor |
| Location | 915 S David St, Casper, Wyoming |
| Authorized Official Name and Position | Diane Rose Edwards (OWNER) |
| Authorized Official Contact | 3074723769 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Develpmental Pediatric Services 915 S David St Casper WY 82601-3737 Ph: (307) 472-3769 | Develpmental Pediatric Services 915 S David St Casper WY 82601-3737 Ph: (307) 472-3769 |
| NPI Number | 1538366075 |
|---|---|
| Provider Enumeration Date | 06/28/2007 |
| Last Update Date | 07/27/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538366075 | NPI | - | NPPES |
| 112255000 | Medicaid | WY | |
| 1003982141 | Other | WY | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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