Healthcare Provider Details

I. General information

NPI: 1689348914
Provider Name (Legal Business Name): ANNIE FLORIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 CONNERY WAY
MISSOULA MT
59808-1954
US

IV. Provider business mailing address

PO BOX 3291
MISSOULA MT
59806-3291
US

V. Phone/Fax

Practice location:
  • Phone: 406-219-1267
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANNIE FLORIN
Title or Position: OWNER
Credential: LCSW
Phone: 406-219-1267