Provider Demographics
NPI:1275661290
Name:ATHMAN, TERESA M (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:ATHMAN
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 FOLEY LANE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-9008
Mailing Address - Country:US
Mailing Address - Phone:406-363-6681
Mailing Address - Fax:
Practice Address - Street 1:575 FOLEY LANE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-9008
Practice Address - Country:US
Practice Address - Phone:406-363-6681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT939235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT662190OtherBLUE CROSS BLUE SHIELD
MT0533324Medicaid
MT662190OtherBCB CHIP