Individual
MR. DAVID E WILTFONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2423 MULLAN RD, MISSOULA, MT 59808-1827
(406) 241-5816
Mailing address
PO BOX 16332, MISSOULA, MT 59808-1830
(406) 241-5816
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SWP-LCSW-LIC-12360
MT
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467829390
—
MT
Enumeration date
08/26/2015
Last updated
11/20/2024
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