Provider Demographics
NPI:1871550541
Name:PIERSON, JAN S (MS, CCC)
Entity type:Individual
Prefix:MRS
First Name:JAN
Middle Name:S
Last Name:PIERSON
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2417
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-2417
Mailing Address - Country:US
Mailing Address - Phone:307-638-0300
Mailing Address - Fax:307-638-0394
Practice Address - Street 1:423 COLE SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5370
Practice Address - Country:US
Practice Address - Phone:307-432-9601
Practice Address - Fax:307-432-0411
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY927231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY308149OtherBLUE CROSS BLUE SHIELD
WY0640004432OtherRR MEDICARE
WY0640004432OtherRR MEDICARE
WY308149OtherBLUE CROSS BLUE SHIELD