Provider Demographics
NPI:1083739106
Name:LINCOLN UINTA CHILD DEVELOPMENT ASSOCIATION
Entity type:Organization
Organization Name:LINCOLN UINTA CHILD DEVELOPMENT ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-782-6601
Mailing Address - Street 1:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:WY
Mailing Address - Zip Code:82939-0570
Mailing Address - Country:US
Mailing Address - Phone:307-782-6601
Mailing Address - Fax:307-782-7328
Practice Address - Street 1:1001 HWY. 414 N.
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:WY
Practice Address - Zip Code:82939-0570
Practice Address - Country:US
Practice Address - Phone:307-782-6601
Practice Address - Fax:307-782-7328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251C00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center