=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073059358
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRUDI MINGUS M.S., SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2017
-----------------------------------------------------
Last Update Date | 10/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2875 TINA AVE
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59808-1581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-541-8778
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 808 S 1ST ST # A
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59840-3016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SLP-SP-LIC-6678
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------