Provider Demographics
NPI:1437280849
Name:MICKEN, LEE (AUD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:MICKEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2567
Mailing Address - Country:US
Mailing Address - Phone:406-586-0914
Mailing Address - Fax:406-586-6667
Practice Address - Street 1:1008 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2567
Practice Address - Country:US
Practice Address - Phone:406-586-0914
Practice Address - Fax:406-586-6667
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0535444Medicaid
MT0569439Medicaid
MT0569439Medicaid
MT000002703Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER