Healthcare Provider Details

I. General information

NPI: 1154640191
Provider Name (Legal Business Name): SUSAN DAY PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W FRONT ST STE 309
MISSOULA MT
59802-4011
US

IV. Provider business mailing address

119 W FRONT ST STE 309
MISSOULA MT
59802-4011
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-9992
  • Fax: 406-327-9987
Mailing address:
  • Phone: 406-327-9992
  • Fax: 406-327-9987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number347
License Number StateMT

VIII. Authorized Official

Name: SUSAN K DAY
Title or Position: SOLE MEMBER
Credential: PHD
Phone: 406-327-9992