Individual
AMANDA JANE FAHLSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
145 MILL TOWN LOOP STE B, BOZEMAN, MT 59718-5144
(406) 219-1350
(406) 219-0749
Mailing address
PO BOX 7003, BOZEMAN, MT 59771-7003
(406) 219-1350
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
37551
MT
Other
Enumeration date
06/13/2019
Last updated
10/06/2021
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