Healthcare Provider Details

I. General information

NPI: 1457662066
Provider Name (Legal Business Name): MICHELLE LYNN DYKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 W MAIN ST STE 218
BELGRADE MT
59714-3700
US

IV. Provider business mailing address

11 W MAIN ST STE 218
BELGRADE MT
59714-3700
US

V. Phone/Fax

Practice location:
  • Phone: 406-388-4988
  • Fax: 406-388-6188
Mailing address:
  • Phone: 406-388-4988
  • Fax: 406-388-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1257
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: