Healthcare Provider Details

I. General information

NPI: 1821757543
Provider Name (Legal Business Name): ALEXIS ROBINSON SWLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/09/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 CEDAR ST
MISSOULA MT
59802-3911
US

IV. Provider business mailing address

1120 CEDAR ST
MISSOULA MT
59802-3911
US

V. Phone/Fax

Practice location:
  • Phone: 406-541-4673
  • Fax:
Mailing address:
  • Phone: 406-541-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: