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Individual

KATIE R. LAKE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
308 MISSION DRIVE, ST IGNATIUS, MT 59864
(406) 745-3575
(406) 745-4233
Mailing address
P.O. BOX 880, ST IGNATIUS, MT 59865
(406) 745-3525
(406) 745-4233

Taxonomy

Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
2969
MT

Other

Enumeration date
05/06/2010
Last updated
05/06/2010
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