Basic Information
| Provider Information | |||||||||
| NPI: | 1295961365 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIEHL | ||||||||
| FirstName: | ALLYSON | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2651 SOUTH AVE W | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598046405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067289162 | ||||||||
| FaxNumber: | 4063292565 | ||||||||
| Practice Location | |||||||||
| Address1: | 2651 SOUTH AVE W | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598046405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067289162 | ||||||||
| FaxNumber: | 4063292565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2009 | ||||||||
| LastUpdateDate: | 05/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 966 | MT | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.