Healthcare Provider Details

I. General information

NPI: 1922965565
Provider Name (Legal Business Name): ELAINE BIRDSLEY SWLC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E GLENDALE ST
DILLON MT
59725-2505
US

IV. Provider business mailing address

125 E GLENDALE ST
DILLON MT
59725-2505
US

V. Phone/Fax

Practice location:
  • Phone: 406-683-4440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-SWLC-LIC-85643
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: