Individual
TIA UTZINGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
937 HIGHLAND BLVD STE 5410, BOZEMAN, MT 59715-6916
(406) 414-2400
Mailing address
915 HIGHLAND BLVD, ATTN PFS CREDENTIALING, BOZEMAN, MT 59715-6902
(406) 414-5000
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-LIC-555
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346636099
—
MT
Enumeration date
04/09/2015
Last updated
10/26/2020
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