MEDICARE: WHITNEY ROSE 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
1	1041C0700X	Clinical Social Worker	BBH-LCSW-LIC-16879	MT

General Provider Information

NPI Number	:	1174977599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY ROSE LCSW

Provider Business Mailing Address
First Line	:	2 KASOTA CT
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-1257
Country	:	US
Telephone Number	:	406-672-5004
Fax Number	:	406-830-3156

Provider Business Practice Location Address
First Line	:	1211 S RESERVE ST STE 101
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-3103
Country	:	US
Telephone Number	:	406-327-3057
Fax Number	:	406-327-3231

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	06/21/2021

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Directions to “ WHITNEY ROSE LCSW” Practice Location

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