Provider Demographics
NPI:1376671412
Name:KRIVONEN, MARY ELLEN (MA CCC-SLP-L)
Entity Type:Individual
Prefix:MRS
First Name:MARY ELLEN
Middle Name:
Last Name:KRIVONEN
Suffix:
Gender:F
Credentials:MA CCC-SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 BLUE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-9162
Mailing Address - Country:US
Mailing Address - Phone:406-248-5206
Mailing Address - Fax:406-259-1777
Practice Address - Street 1:50 27TH ST W STE A
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-8602
Practice Address - Country:US
Practice Address - Phone:406-259-1680
Practice Address - Fax:406-259-1777
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
MT302235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist