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Individual

DR. MARY A JENNI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1640 SOUTH AVE W, MISSOULA, MT 59801
(406) 829-1515
Mailing address
137 CRESTVIEW LN, MISSOULA, MT 59803-1437
(406) 829-1515

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
122
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0492422
MT
01
52010
BLUE CROSS BLUE SHIELD
MT
Enumeration date
08/21/2006
Last updated
07/08/2007
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