Individual
ELIZABETH CHARLAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
203 MAIN STREET, POLSON, MT 59860
(406) 883-4061
Mailing address
1208 EAST 986 SOUTH, SALT LAKE CITY, UT 84108-1222
(801) 710-1970
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
8224944-3502
UT
1041C0700X
Clinical Social Worker
SWP-LCSW-LIC-10759
MT
Other
Enumeration date
10/03/2012
Last updated
12/30/2014
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