Provider Demographics
NPI:1790865889
Name:INGALLS, PATRICIA M (AUD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:M
Last Name:INGALLS
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 1:1369 HARRISON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4875
Mailing Address - Country:US
Mailing Address - Phone:406-723-6600
Mailing Address - Fax:406-723-6660
Practice Address - Street 1:1369 HARRISON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-4875
Practice Address - Country:US
Practice Address - Phone:406-723-6600
Practice Address - Fax:406-723-6660
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT248231H00000X
MT141237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0530374Medicaid
MT029028OtherBLUECROSS BLUESHIELD
WA0151151OtherWASH LABOR & INDUSTRY
MT0569400Medicaid
MTR09569Medicare UPIN
MT029028OtherBLUECROSS BLUESHIELD
640003045Medicare ID - Type UnspecifiedRAILROAD MEDICARE