Healthcare Provider Details

I. General information

NPI: 1972665768
Provider Name (Legal Business Name): DIANA L. BJORGEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W SPRUCE ST
MISSOULA MT
59802-4107
US

IV. Provider business mailing address

PO BOX 1328
FLORENCE MT
59833-1328
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-9697
  • Fax: 406-273-7601
Mailing address:
  • Phone: 406-273-7600
  • Fax: 406-273-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number307
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: