Healthcare Provider Details

I. General information

NPI: 1679734537
Provider Name (Legal Business Name): ASHLEY RAQUEL ANDERSON AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 14TH AVE SW
SIDNEY MT
59270-3521
US

IV. Provider business mailing address

214 14TH AVE SW
SIDNEY MT
59270-3521
US

V. Phone/Fax

Practice location:
  • Phone: 406-488-2510
  • Fax: 406-488-2125
Mailing address:
  • Phone: 406-488-2510
  • Fax: 406-488-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1184
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number379
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: