Healthcare Provider Details

I. General information

NPI: 1619622123
Provider Name (Legal Business Name): JESSIKA EISKANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2283 DEPOT WAY
MISSOULA MT
59808-6018
US

IV. Provider business mailing address

748 MAIN ST
LANDER WY
82520-3036
US

V. Phone/Fax

Practice location:
  • Phone: 406-465-3280
  • Fax:
Mailing address:
  • Phone: 406-465-3280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: