Provider Demographics
NPI:1700258019
Name:SPILLMAN, DUSTIN (AUD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:SPILLMAN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 HERITAGE WAY
Mailing Address - Street 2:STE 201
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3161
Mailing Address - Country:US
Mailing Address - Phone:406-752-1014
Mailing Address - Fax:406-756-1379
Practice Address - Street 1:160 HERITAGE WAY
Practice Address - Street 2:STE 201
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3161
Practice Address - Country:US
Practice Address - Phone:406-752-1014
Practice Address - Fax:406-756-1379
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5221237600000X, 237700000X, 231H00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No332S00000XSuppliersHearing Aid Equipment