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Individual

KIMBERLY CANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
2112 DIXON AVE, MISSOULA, MT 59801-8226
(406) 319-5821
Mailing address
PO BOX 7496, MISSOULA, MT 59807-7496

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
MT
1041C0700X
Clinical Social Worker

Other

Enumeration date
11/02/2022
Last updated
02/27/2023
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