Healthcare Provider Details

I. General information

NPI: 1780956300
Provider Name (Legal Business Name): JESSICA MCDANOLD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 4TH ST SW
SIDNEY MT
59270-3515
US

IV. Provider business mailing address

PO BOX 1407
SIDNEY MT
59270-1407
US

V. Phone/Fax

Practice location:
  • Phone: 406-643-4095
  • Fax: 406-433-3586
Mailing address:
  • Phone: 406-643-4095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1007
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number108
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: