Healthcare Provider Details

I. General information

NPI: 1265128813
Provider Name (Legal Business Name): HANNA MARIE KNUDSEN PCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E MENDENHALL ST STE H
BOZEMAN MT
59715-3680
US

IV. Provider business mailing address

906 GROUSE BERRY ST
BILLINGS MT
59106-8548
US

V. Phone/Fax

Practice location:
  • Phone: 406-595-3746
  • Fax: 406-578-1363
Mailing address:
  • Phone: 541-531-7968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBHPCLCLIC57631
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: