MEDICARE: DAVID C SEGERSTROM PC

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	220	MT

General Provider Information

NPI Number	:	1225043102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID C SEGERSTROM PC

Provider Business Mailing Address
First Line	:	38 VILLAGE LOOP RD
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-2793
Country	:	US
Telephone Number	:	406-755-7566
Fax Number	:	406-755-7599

Provider Business Practice Location Address
First Line	:	38 VILLAGE LOOP RD
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-2793
Country	:	US
Telephone Number	:	406-755-7566
Fax Number	:	406-755-7599

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID CHARLES SEGERSTROM
Credential	:	LCSW
Telephone Number	:	406-755-7566

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	07/21/2022

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