Healthcare Provider Details

I. General information

NPI: 1710047642
Provider Name (Legal Business Name): DEVELOPMENTAL EDUCATIONAL ASSISTANCE PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BOX ELDER ST
MILES CITY MT
59301-2899
US

IV. Provider business mailing address

2200 BOX ELDER ST
MILES CITY MT
59301-2899
US

V. Phone/Fax

Practice location:
  • Phone: 406-234-6034
  • Fax: 406-234-7018
Mailing address:
  • Phone: 406-234-6034
  • Fax: 406-234-7018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LINDA WILKINS
Title or Position: FINANCIAL MANAGER
Credential:
Phone: 406-234-6034