Healthcare Provider Details

I. General information

NPI: 1194387365
Provider Name (Legal Business Name): JENNA MARCEAU MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SW HIGGINS AVE STE 107
MISSOULA MT
59803-1489
US

IV. Provider business mailing address

307 S CALIFORNIA ST
MISSOULA MT
59801-2319
US

V. Phone/Fax

Practice location:
  • Phone: 406-214-3810
  • Fax:
Mailing address:
  • Phone: 303-518-5128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number54987
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: