Healthcare Provider Details

I. General information

NPI: 1720478886
Provider Name (Legal Business Name): LORI MARIANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 DANIELSON ROAD
KALISPELL MT
59901
US

IV. Provider business mailing address

3805 TAMARACK AVE
WHITEFISH MT
59937-8069
US

V. Phone/Fax

Practice location:
  • Phone: 406-758-8164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11384
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: