Provider Demographics
NPI:1912128521
Name:GRIFFIN, JEFFREY D (MS,CCC-A)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MS,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 15TH AVE S, STE 207
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4334
Mailing Address - Country:US
Mailing Address - Phone:406-727-6577
Mailing Address - Fax:406-727-6577
Practice Address - Street 1:401 15TH AVE S, STE 207
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4334
Practice Address - Country:US
Practice Address - Phone:406-727-6577
Practice Address - Fax:406-727-6577
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT395231H00000X
MT150332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000532372Medicaid
MT0144546OtherST OF WA WORK COMP
MT0000561323Medicaid
MT605313300OtherDEPT OF LABOR
MT29048OtherBCBS
MT29048OtherBCBS