Provider Demographics
NPI:1548537434
Name:THE UNIVERSITY OF MONTANA
Entity type:Organization
Organization Name:THE UNIVERSITY OF MONTANA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-243-5189
Mailing Address - Street 1:COMMUNICATIVE SCIENCES AND DISORDERS 32 CAMPUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59812-6695
Mailing Address - Country:US
Mailing Address - Phone:406-243-2405
Mailing Address - Fax:406-243-6678
Practice Address - Street 1:CURRY HEALTH CENTER LOWER LEVEL
Practice Address - Street 2:634 EDDY AVENUE
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-0001
Practice Address - Country:US
Practice Address - Phone:406-243-2405
Practice Address - Fax:406-243-6678
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE UNIVERSITY OF MONTANA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-21
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1314235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty