Healthcare Provider Details

I. General information

NPI: 1689538290
Provider Name (Legal Business Name): JEFFREY D WALROD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 W BROADWAY ST
MISSOULA MT
59808-5796
US

IV. Provider business mailing address

111 HILLCREST LOOP
MISSOULA MT
59803-1630
US

V. Phone/Fax

Practice location:
  • Phone: 406-447-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-84891
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: