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NPI Code Detail

MEDICARE: MCKENNA LEIGH FROMM LCSW

MEDICARE: MCKENNA LEIGH FROMM LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker78779MT

General Provider Information

NPI Number : 1003614595
Entity Type Code : Individual
Provider Name (Legal Business Name) : MCKENNA LEIGH FROMM LCSW
Provider Business Mailing Address
First Line : 5004 VICTOR CT
Second Line :
City : MISSOULA
State : MT
Zip : 59803-9678
Country : US
Telephone Number : 406-899-9339
Fax Number :
Provider Business Practice Location Address
First Line : 3885 W BROADWAY ST
Second Line :
City : MISSOULA
State : MT
Zip : 59808-5796
Country : US
Telephone Number : 406-465-8725
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2025
Last Update Date : 03/03/2025

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Directions to “ MCKENNA LEIGH FROMM LCSW” Practice Location

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