Provider Demographics
NPI:1316364557
Name:LONGSTRETH, DANA (SLP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:LONGSTRETH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 OSLOSKI RD
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-9058
Mailing Address - Country:US
Mailing Address - Phone:406-297-3915
Mailing Address - Fax:406-297-3919
Practice Address - Street 1:298 OSLOSKI RD
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917-9058
Practice Address - Country:US
Practice Address - Phone:406-297-3915
Practice Address - Fax:406-297-3919
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3459235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist