MEDICARE: MR. ROBERT J. PIERSALL M.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	199	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	07006-1	OTHER	MT	BCBS OF MONTANA

General Provider Information

NPI Number	:	1134333610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT J. PIERSALL M.S.W.

Provider Business Mailing Address
First Line	:	725 6TH AVE E
Second Line	:	SUITE 12
City	:	KALISPELL
State	:	MT
Zip	:	59901-5005
Country	:	US
Telephone Number	:	406-755-3134
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 6TH AVE E
Second Line	:	SUITE 12
City	:	KALISPELL
State	:	MT
Zip	:	59901-5005
Country	:	US
Telephone Number	:	406-755-3134
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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