Individual
MRS. SUSAN KAY ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
415 N HIGGINS, SUITE 4, MISSOULA, MT 59802-4559
(406) 303-0397
(406) 721-5912
Mailing address
PO BOX 353, MISSOULA, MT 59806-0353
(406) 303-0397
(406) 721-5912
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
630
MT
1041C0700X
Clinical Social Worker
Primary
630
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M011006202
MEDICARE PTAN
MT
Enumeration date
03/02/2011
Last updated
07/29/2015
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