Healthcare Provider Details

I. General information

NPI: 1902165491
Provider Name (Legal Business Name): CRYSTAL BLEU DVORAK AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL BLEU MUGLIA

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N 27TH ST SUITE E
BILLINGS MT
59101-0101
US

IV. Provider business mailing address

1101 N 27TH ST SUITE E
BILLINGS MT
59101-0101
US

V. Phone/Fax

Practice location:
  • Phone: 406-245-6893
  • Fax: 406-245-9954
Mailing address:
  • Phone: 406-245-6893
  • Fax: 406-245-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: