Healthcare Provider Details

I. General information

NPI: 1336941558
Provider Name (Legal Business Name): DAISY MARIE SELLS ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 FAIRVIEW AVE STE A
MISSOULA MT
59801-7873
US

IV. Provider business mailing address

620 FAIRVIEW AVE
MISSOULA MT
59801-8057
US

V. Phone/Fax

Practice location:
  • Phone: 406-214-3810
  • Fax:
Mailing address:
  • Phone: 406-240-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-SWLC-LIC-78994
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: