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General NPI Number Information
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NPI Number | 1225043102
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Entity Type | Organization
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Legal Business Name | DAVID C SEGERSTROM PC
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 38 VILLAGE LOOP RD
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City | KALISPELL
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State | MT
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Zip | 59901-2793
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Country | US
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Telephone | 406-755-7566
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Fax | 406-755-7599
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Provider Business Mailing Address
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Address Line | 38 VILLAGE LOOP RD
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City | KALISPELL
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State | MT
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Zip | 59901-2793
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Country | US
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Telephone | 406-755-7566
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Fax | 406-755-7599
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID CHARLES SEGERSTROM
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Credential | LCSW
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Telephone | 406-755-7566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 220
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License Number State | MT
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