| NPI | 1851032262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER JOHNSON Credentialing Specialist 406-454-5074 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 207K00000X Allergy & Immunology |
| 225100000X Physical Therapist | |
| 247100000X Radiologic Technologist | |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2024-10-21 |