Individual
DR. JENNIFER ANNE WALTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
519 S 4TH ST W, MISSOULA, MT 59801-2629
(406) 370-0984
Mailing address
519 SOUTH FOURTH STREET WEST, MISSOULA, MT 59801
(406) 370-0984
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
303
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54751
BLUE CROSS BLUE SHIELD
MT
Enumeration date
05/21/2007
Last updated
07/08/2007
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