EARLY INTERVENTION PROGRAM (NPI# 1104152388) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104152388 |
| Entity Type | Organization |
| Organization Name | EARLY INTERVENTION PROGRAM |
| Practice Address |
90 Ethete Road Fort Washakie WY 82514 |
| Mailing Address |
Po Box 610 Fort Washakie WY 82514-0610 |
| Practice Telephone | 3073323516 |
| Practice Fax Number | 3073329116 |
| Mailing Telephone | 3073323516 |
| Mailing Fax Number | 3073329116 |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2009-10-23 |
| Authorized Official Name | MRS. SUE JEZEK (DIRECTOR) |
| Authorized Official Telephone | 3073323516 |
| Authorized Official Credential | SLP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251C00000X | Day Training, Developmentally Disabled Services | Agencies |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831581719 | Early Intervention Program | Early Intervention Provider Agency | 9 Shipton Lane, Fort Washakie, WY 82514-0610 | 2015-03-02 |
| 1982933065 | Early Intervention Program | Day Training, Developmentally Disabled Services | 9 Fort Washakie School Rd, Fort Washakie, WY 82514-9601 | 2009-12-18 |
| 1134127251 | Early Intervention Program | Early Intervention Provider Agency | 60 Central Ave, Cortland, NY 13045-2746 | 2005-07-12 |
| Street Address |
90 ETHETE ROAD |
| City | FORT WASHAKIE |
| State | WY |
| Zip Code | 82514 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003020744 | Dehning Jo Dehning | Physical Therapist | 90 Ethete Road, Fort Washakie, WY 82514 | 2007-05-10 |
| 1417003161 | Jan S Keith | Occupational Therapy Assistant | 90 Ethete Road, Fort Washakie, WY 82514 | 2007-01-26 |
| 1558425207 | Shoshone Tribe Early Intervention Program | Local Education Agency (LEA) | 90 Ethete Road, Fort Washakie, WY 82514-0610 | 2006-12-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619527819 | Melissa Rose Pine | Registered Nurse | 29 Blackcole Road, Fort Washakie, WY 82514 | 2019-09-19 |
| 1982116794 | Madonna Lee Kienlen | Peer Specialist | 215 Ethete Road, Ft. Washakie, WY 82514 | 2017-11-02 |
| 1649789025 | Rebecca Charlene Willis | Technician, Other | Fort Washakie Healt Center Lab Ihs 29 Black Coal Drive, Fort Washakie, WY 82514 | 2017-09-28 |
| 1033553185 | Pauline Elizabeth Powers-peprah | Family Medicine | 29 Black Cole, Fort Washakie, WY 82514 | 2013-04-19 |
| 1528319373 | Amanda L Schultz | Licensed Practical Nurse | 110 Sharpnose Road, Fort Washakie, WY 82514 | 2012-09-19 |
| 1770898140 | Kelly Lynne Pretty Weasel | Clinic/Center | 29 Blackcole Dr, Fort Washakie, WY 82514 | 2010-08-10 |
| 1285950170 | Debra Kay Waters | Technician, Pathology | Black Coal Rd. Bldg. 29, Ft. Washakie, WY 82514 | 2010-04-16 |
| 1881919751 | Shoshone & Arapaho Tribal Substance Abuse Court | Clinic/Center | 215 Ethete Rd, Fort Washakie, WY 82514 | 2010-04-02 |
| 1770814253 | Christopher G Nelson | Spec/Tech, Pathology | 29 Black Coal Rd, Ft. Washakie, WY 82514 | 2010-01-22 |
| 1922339449 | Nina Williams | Spec/Tech, Pathology | Black Coal Rd Bldg 29, Ft Washakie, WY 82514 | 2010-01-22 |
| Find all providers in zip 82514 | ||||
| Taxonomy Code | 251C00000X |
| Grouping | Agencies |
| Classification | Day Training, Developmentally Disabled Services |
| These agencies are authorized to provide day habilitation services to developmentally disabled individuals who live in their homes. The function of day habilitation is to assist an individual to acquire and maintain those life skills that enable the individual to cope more effectively with the demands of independent living. Also to raise the level of the individual's physical, mental, social, and vocational functioning. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982933065 | Early Intervention Program | Day Training, Developmentally Disabled Services | 9 Fort Washakie School Rd, Fort Washakie, WY 82514-9601 | 2009-12-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013524628 | Mac Patrik Reynolds | Day Training, Developmentally Disabled Services | 620 W Prosser Rd Lot H, Cheyenne, WY 82007-3054 | 2020-09-28 |
| 1780201483 | Richard Doug Bebout | Day Training, Developmentally Disabled Services | 535 Pioneer Ave, Riverton, WY 82501-3248 | 2020-06-29 |
| 1376169128 | Jodi Thornhill | Day Training, Developmentally Disabled Services | 900 Camel Dr. Ste. Gg, Pmb #154, Gillette, WY 82716-4974 | 2020-06-17 |
| 1235751389 | B.a.c.a. Case Managment LLC | Day Training, Developmentally Disabled Services | 6500 Longabaugh Way, Cheyenne, WY 82009-9699 | 2020-05-12 |
| 1861012866 | Aunkia Fowler and Associates LLC | Day Training, Developmentally Disabled Services | 8101 Shady Lane, Evansville, WY 82636 | 2020-04-20 |
| 1194356782 | Rebekah Vondenkamp | Day Training, Developmentally Disabled Services | 832 Walnut St, Rock Springs, WY 82901-7104 | 2020-01-31 |
| 1689224305 | Care Partners of Wyoming | Day Training, Developmentally Disabled Services | 142 N Melrose St, Casper, WY 82601-2735 | 2019-09-14 |
| 1366910770 | Haley D Gray | Day Training, Developmentally Disabled Services | 3800 Overdale Dr, Gillette, WY 82718-7633 | 2018-11-05 |
| 1578043006 | Elaina Elizabeth Oliver | Day Training, Developmentally Disabled Services | 3832 Andersen Ln, Wilson, WY 83014-9194 | 2018-08-15 |
| 1073009403 | Christopher Aaron Grooms | Day Training, Developmentally Disabled Services | 1745 E 22nd St, Cheyenne, WY 82001-4138 | 2018-07-09 |
| Find all providers with the same taxonomy | ||||
| City | FORT WASHAKIE |
| Zip Code | 82514 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.