Individual
LISA HERMANSSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
520 32ND ST N, GREAT FALLS, MT 59401-2127
(630) 862-4881
Mailing address
4129 6TH AVE S, GREAT FALLS, MT 59405-3744
(630) 861-4881
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
50057
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50057
MEDICAID
MT
Enumeration date
06/01/2022
Last updated
06/01/2022
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