Healthcare Provider Details

I. General information

NPI: 1386605053
Provider Name (Legal Business Name): DEBORAH JO FJELSTROM LCSW, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JO FJELSTROM

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 11/27/2023
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 BURNS WAY
KALISPELL MT
59901
US

IV. Provider business mailing address

1287 BURNS WAY
KALISPELL MT
59901-3109
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-8120
  • Fax:
Mailing address:
  • Phone: 406-752-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-32125
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.00000342
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: