Provider Demographics
NPI:1104862416
Name:MIKUS, DEBRA L (MS)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:MIKUS
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 S ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1810
Mailing Address - Country:US
Mailing Address - Phone:406-549-1951
Mailing Address - Fax:406-542-5682
Practice Address - Street 1:299 FAIRGROUNDS RD UNIT 4
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3199
Practice Address - Country:US
Practice Address - Phone:406-549-1951
Practice Address - Fax:406-542-5682
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13817237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS2911ZMedicare ID - Type UnspecifiedIND PROV ID #