Provider Demographics
NPI:1538448063
Name:EBIA, WALTER (HAS)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:
Last Name:EBIA
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 SUGARLAND DR
Mailing Address - Street 2:252
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5755
Mailing Address - Country:US
Mailing Address - Phone:307-674-8920
Mailing Address - Fax:307-674-1916
Practice Address - Street 1:1949 SUGARLAND DR
Practice Address - Street 2:252
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5755
Practice Address - Country:US
Practice Address - Phone:307-674-8920
Practice Address - Fax:307-674-1916
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY53237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist