Healthcare Provider Details

I. General information

NPI: 1932724960
Provider Name (Legal Business Name): TAHJ B KJELLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 04/19/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 MILWAUKEE WAY
MISSOULA MT
59801-3006
US

IV. Provider business mailing address

PO BOX 2751
MISSOULA MT
59806-2751
US

V. Phone/Fax

Practice location:
  • Phone: 406-818-1111
  • Fax:
Mailing address:
  • Phone: 406-818-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33128
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33128
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: