Healthcare Provider Details

I. General information

NPI: 1992495774
Provider Name (Legal Business Name): JADE-HEATHER MARANDA HINMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JADE-HEATHER MARANDA ACKERMAN

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N 2ND ST W
MISSOULA MT
59802-3616
US

IV. Provider business mailing address

PO BOX 2
POPLAR MT
59255-0002
US

V. Phone/Fax

Practice location:
  • Phone: 406-214-3810
  • Fax:
Mailing address:
  • Phone: 406-450-2769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-SWLC-LIC-57348
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: