Provider Demographics
NPI:1750974762
Name:MONGER, ASPEN DEIGH
Entity type:Individual
Prefix:
First Name:ASPEN
Middle Name:DEIGH
Last Name:MONGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 NIXON GULCH RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:MT
Mailing Address - Zip Code:59741-8005
Mailing Address - Country:US
Mailing Address - Phone:406-589-6091
Mailing Address - Fax:
Practice Address - Street 1:201 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-3958
Practice Address - Country:US
Practice Address - Phone:406-595-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-20091225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist