Individual
DR. WANMDIWI JESSI ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
600 CENTRAL AVE STE 311, GREAT FALLS, MT 59401-3157
(406) 866-0013
Mailing address
300 POPLAR LN, FLORENCE, MT 59833-6834
(713) 494-3341
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY-PSY-LIC-2506
MT
103T00000X
Psychologist
PY60720535
WA
Other
Enumeration date
01/26/2018
Last updated
12/01/2021
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