Healthcare Provider Details

I. General information

NPI: 1245821644
Provider Name (Legal Business Name): KATHRYN ROSSETTO FRUTIGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 TAMARACK CREEK RD
WHITEFISH MT
59937-7139
US

IV. Provider business mailing address

PO BOX 5318
WHITEFISH MT
59937-5318
US

V. Phone/Fax

Practice location:
  • Phone: 907-202-0126
  • Fax:
Mailing address:
  • Phone: 907-202-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberBBH-LCSW-LIC-48179
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number199825
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: