Healthcare Provider Details

I. General information

NPI: 1598433484
Provider Name (Legal Business Name): KURT HERMAN STIMPFLING MSW SWLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W FRONT ST #108
MISSOULA MT
59802-4332
US

IV. Provider business mailing address

918 A ST
MISSOULA MT
59802-3609
US

V. Phone/Fax

Practice location:
  • Phone: 406-272-1872
  • Fax:
Mailing address:
  • Phone: 406-272-1872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-SWLC-LIC-48304
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: