Healthcare Provider Details

I. General information

NPI: 1538192356
Provider Name (Legal Business Name): JENNIFER E. SCALISE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WEST BROADWAY
MISSOULA MT
59802
US

IV. Provider business mailing address

PO BOX 31001-4110
PASADENA CA
91110-4110
US

V. Phone/Fax

Practice location:
  • Phone: 406-721-5600
  • Fax: 406-721-5600
Mailing address:
  • Phone: 406-329-5828
  • Fax: 406-329-5864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number558
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0003014
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMED-PAC-LIC-558
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: