Provider Demographics
NPI:1326241787
Name:WILTSHIRE-SCALA, NICHOLE MARIE
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:MARIE
Last Name:WILTSHIRE-SCALA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NICHOLE
Other - Middle Name:
Other - Last Name:SCALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:15 BLUE GROUSE CT
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-0648
Mailing Address - Country:US
Mailing Address - Phone:406-586-5609
Mailing Address - Fax:406-586-5609
Practice Address - Street 1:720 STONERIDGE DR
Practice Address - Street 2:UNIT 2
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7032
Practice Address - Country:US
Practice Address - Phone:406-586-5609
Practice Address - Fax:406-586-5609
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSP986235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT662360OtherBLUE CROSS BLUE SHIELD MT
MT1285783506OtherCORPORATE NPI NUMBER
MT1285783506OtherCORPORATE NPI NUMBER