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General NPI Number Information
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NPI Number | 1154640191
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Entity Type | Organization
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Legal Business Name | SUSAN DAY PHD LLC
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Dates
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Enumeration Date | 05/28/2010
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Last Update Date | 05/28/2010
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Provider Practice Location Address
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Address Line | 119 W FRONT ST STE 309
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City | MISSOULA
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State | MT
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Zip | 59802-4011
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Country | US
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Telephone | 406-327-9992
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Fax | 406-327-9987
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Provider Business Mailing Address
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Address Line | 119 W FRONT ST STE 309
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City | MISSOULA
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State | MT
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Zip | 59802-4011
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Country | US
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Telephone | 406-327-9992
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Fax | 406-327-9987
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | SUSAN K DAY
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Credential | PHD
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Telephone | 406-327-9992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 347
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License Number State | MT
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