Provider Demographics
NPI:1902165491
Name:DVORAK, CRYSTAL BLEU (AUD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:BLEU
Last Name:DVORAK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:BLEU
Other - Last Name:MUGLIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 N 27TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0101
Mailing Address - Country:US
Mailing Address - Phone:406-245-6893
Mailing Address - Fax:406-245-9954
Practice Address - Street 1:1101 N 27TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0101
Practice Address - Country:US
Practice Address - Phone:406-245-6893
Practice Address - Fax:406-245-9954
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter