Provider Demographics
NPI:1720148406
Name:TURNER, DIEDRE (MA)
Entity Type:Individual
Prefix:
First Name:DIEDRE
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 S MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5422
Mailing Address - Country:US
Mailing Address - Phone:406-443-3945
Mailing Address - Fax:406-443-5436
Practice Address - Street 1:309 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3552
Practice Address - Country:US
Practice Address - Phone:406-443-3945
Practice Address - Fax:406-443-5436
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT187235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT661830OtherBCBS PROVIDER NIMBER
MT532678Medicaid