Individual
MS. LISA RAE BIRNBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.S
Contact information
Practice address
325 E CENTRAL AVE, MISSOULA, MT 59801-6914
(406) 370-1771
Mailing address
325 E CENTRAL AVE, MISSOULA, MT 59801-6914
(406) 370-1771
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
72601
MT
Other
Enumeration date
10/12/2021
Last updated
10/12/2021
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