MEDICARE: ST JOHNS LUTHERAN MINISTRIES INC

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

General Provider Information

NPI Number	:	1457847972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JOHNS LUTHERAN MINISTRIES INC

Provider Business Mailing Address
First Line	:	2429 MISSION WAY
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-0161
Country	:	US
Telephone Number	:	406-655-5425
Fax Number	:

Provider Business Practice Location Address
First Line	:	2429 MISSION WAY
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-0161
Country	:	US
Telephone Number	:	406-655-5425
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF FAMILY SERVICES
Name	:	TRUDI PAULSON
Credential	:	LCSW
Telephone Number	:	406-655-5245

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	09/07/2021

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