Healthcare Provider Details

I. General information

NPI: 1699518969
Provider Name (Legal Business Name): JANE TOROK SWLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 W MAIN ST STE 8C
BOZEMAN MT
59715-6821
US

IV. Provider business mailing address

215 MARTINEZ SPRING RD
BOZEMAN MT
59718-7820
US

V. Phone/Fax

Practice location:
  • Phone: 406-813-0301
  • Fax:
Mailing address:
  • Phone: 406-548-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-SWLC-LIC-64878
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: