Provider Demographics
NPI:1235274457
Name:VAN DE RIET, DONALD ROY (HEARING INSTRUMENT S)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ROY
Last Name:VAN DE RIET
Suffix:
Gender:M
Credentials:HEARING INSTRUMENT S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2632
Mailing Address - Country:US
Mailing Address - Phone:406-727-7269
Mailing Address - Fax:406-452-5145
Practice Address - Street 1:725 1ST AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-2632
Practice Address - Country:US
Practice Address - Phone:406-727-7269
Practice Address - Fax:406-452-5145
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT179237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0566774Medicaid