Healthcare Provider Details

I. General information

NPI: 1245368315
Provider Name (Legal Business Name): RONI KAY LETT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON KAY LETT PHD

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 S 6TH ST W
MISSOULA MT
59801
US

IV. Provider business mailing address

128 S 6TH ST W
MISSOULA MT
59801
US

V. Phone/Fax

Practice location:
  • Phone: 406-543-8415
  • Fax:
Mailing address:
  • Phone: 406-543-8415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSYCH218
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: