Provider Demographics
NPI:1538457791
Name:VANDERIET, MIKE R (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:R
Last Name:VANDERIET
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 S. RESERVE ST. #B
Mailing Address - Street 2:(HEARING AID INSTITUTE OF MISSOULA)
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801
Mailing Address - Country:US
Mailing Address - Phone:406-543-5025
Mailing Address - Fax:406-721-6071
Practice Address - Street 1:705 S. RESERVE ST. #B
Practice Address - Street 2:(HEARING AID INSTITUTE OF MISSOULA)
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-543-5025
Practice Address - Fax:406-721-6071
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT235237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist