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General NPI Number Information
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NPI Number | 1750974762
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Entity Type | Individual
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Provider Name | ASPEN DEIGH MONGER
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Gender | Female
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 201 W MADISON AVE
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City | BELGRADE
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State | MT
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Zip | 59714-3958
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Country | US
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Telephone | 406-595-0040
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Fax |
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Provider Business Mailing Address
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Address Line | 875 NIXON GULCH RD
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City | MANHATTAN
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State | MT
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Zip | 59741-8005
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Country | US
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Telephone | 406-589-6091
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | LMT-LMT-LIC-20091
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License Number State | MT
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