Provider Demographics
NPI:1477344430
Name:ILAC, MARIA (MA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:ILAC
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:BENNY
Other - Middle Name:
Other - Last Name:ILAC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:3520 AMERICAN WAY APT 204
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1788
Mailing Address - Country:US
Mailing Address - Phone:425-985-9454
Mailing Address - Fax:
Practice Address - Street 1:32 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-0004
Practice Address - Country:US
Practice Address - Phone:406-243-4521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program