Provider Demographics
NPI:1427116276
Name:DIAMANT, ELLEN-SUE (SLPD)
Entity type:Individual
Prefix:DR
First Name:ELLEN-SUE
Middle Name:
Last Name:DIAMANT
Suffix:
Gender:F
Credentials:SLPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:MILE 206 HWY 2
Mailing Address - City:EAST GLACIER PARK
Mailing Address - State:MT
Mailing Address - Zip Code:59434-0227
Mailing Address - Country:US
Mailing Address - Phone:406-226-4224
Mailing Address - Fax:
Practice Address - Street 1:615 S. PIEGAN
Practice Address - Street 2:
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417
Practice Address - Country:US
Practice Address - Phone:406-226-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT771235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0531349Medicaid