Healthcare Provider Details

I. General information

NPI: 1437836244
Provider Name (Legal Business Name): MANDI-MAE IRIS THOMPSON L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 EXPRESSWAY STE A
MISSOULA MT
59808-1571
US

IV. Provider business mailing address

GENERAL DELIVERY 326 SPRUCE CONE DR
BIG SKY MT
59716-9999
US

V. Phone/Fax

Practice location:
  • Phone: 402-613-0382
  • Fax:
Mailing address:
  • Phone: 402-613-0382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number117209
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number24563
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: