Provider Demographics
NPI:1437810553
Name:DURGLO, ALANA JEAN
Entity Type:Individual
Prefix:
First Name:ALANA
Middle Name:JEAN
Last Name:DURGLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-0505
Mailing Address - Country:US
Mailing Address - Phone:406-207-6275
Mailing Address - Fax:
Practice Address - Street 1:34898 REPASS TRL
Practice Address - Street 2:
Practice Address - City:SAINT IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-9709
Practice Address - Country:US
Practice Address - Phone:406-207-6275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-02
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-DP-LIC-705235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist