Healthcare Provider Details

I. General information

NPI: 1598956161
Provider Name (Legal Business Name): JEFF WILLIAMSON AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 9TH ST S
GREAT FALLS MT
59405-4402
US

IV. Provider business mailing address

1102 9TH ST S STE 102
GREAT FALLS MT
59405-4402
US

V. Phone/Fax

Practice location:
  • Phone: 406-727-3115
  • Fax: 406-727-4484
Mailing address:
  • Phone: 406-727-3115
  • Fax: 406-727-4484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5916
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number5916
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: