Healthcare Provider Details

I. General information

NPI: 1225672991
Provider Name (Legal Business Name): MARINA SPRING RUNNINGCRANE SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 11/15/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PUBLIC SQ
BROWNING MT
59417-5316
US

IV. Provider business mailing address

PO BOX 1289
BROWNING MT
59417-1289
US

V. Phone/Fax

Practice location:
  • Phone: 406-338-3123
  • Fax:
Mailing address:
  • Phone: 406-338-7912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25777
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: