Provider Demographics
NPI:1639270259
Name:MILLER, BRENT DAL (CCC-A)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:DAL
Last Name:MILLER
Suffix:
Gender:M
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 6369
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604
Mailing Address - Country:US
Mailing Address - Phone:406-447-2828
Mailing Address - Fax:406-447-2825
Practice Address - Street 1:2525 BROADWAY
Practice Address - Street 2:SUITE 105
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-457-4160
Practice Address - Fax:406-457-4179
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT996231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT290448OtherBCBS OF MT
MT0534684Medicaid
MTP33424Medicare UPIN