MEDICARE: TRUDI MINGUS M.S., SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP-SP-LIC-6678	MT

General Provider Information

NPI Number	:	1073059358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRUDI MINGUS M.S., SLP

Provider Business Mailing Address
First Line	:	808 S 1ST ST # A
Second Line	:
City	:	HAMILTON
State	:	MT
Zip	:	59840-3016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2875 TINA AVE
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1581
Country	:	US
Telephone Number	:	406-541-8778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2017
Last Update Date	:	10/11/2024

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