Individual
DUDLEY DANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
815 E FRONT ST STE 1, MISSOULA, MT 59802-5600
(406) 549-4088
Mailing address
815 E FRONT ST STE 1, MISSOULA, MT 59802-5600
(406) 549-4088
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
225
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0492297
—
MT
01
—
53090
BLUE CROSS BLUE SHIELD
MT
Enumeration date
03/28/2007
Last updated
07/08/2007
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