Provider Demographics
NPI:1093977597
Name:SPONHEIM, PATRICIA ANN (BC-HIS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:SPONHEIM
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 10TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-2212
Mailing Address - Country:US
Mailing Address - Phone:406-727-2461
Mailing Address - Fax:406-452-5953
Practice Address - Street 1:215 10TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2212
Practice Address - Country:US
Practice Address - Phone:406-727-2461
Practice Address - Fax:406-452-5953
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT239237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000561306Medicaid