Individual
JORDAN SIERRA PRUSSACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1417 9TH ST S STE 300, GREAT FALLS, MT 59405-4509
(503) 449-1807
Mailing address
6593 LAKE FOREST DR, NINE MILE FLS, WA 99026-9544
(503) 449-1807
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
BBH-LCSW-LIC-33322
MT
Other
Enumeration date
03/06/2020
Last updated
03/06/2020
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