Provider Demographics
NPI:1154622355
Name:UNIVERSITY OF WYOMING - WYOMING INSTITUTE FOR DISABILITIES
Entity type:Organization
Organization Name:UNIVERSITY OF WYOMING - WYOMING INSTITUTE FOR DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:MACLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:307-766-2761
Mailing Address - Street 1:1000 E UNIVERSITY AVE
Mailing Address - Street 2:UNIVERSITY OF WYOMING, DEPT. 4298
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82071-2000
Mailing Address - Country:US
Mailing Address - Phone:307-766-2761
Mailing Address - Fax:307-766-2763
Practice Address - Street 1:1000 E UNIVERSITY AVE
Practice Address - Street 2:UNIVERSITY OF WYOMING, DEPT. 4298
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82071-2000
Practice Address - Country:US
Practice Address - Phone:307-766-2761
Practice Address - Fax:307-766-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY287103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty