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NPI Code Detail

MEDICARE: DIANE S. PAGE LCSW

MEDICARE: DIANE S. PAGE 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 Worker545MT

General Provider Information

NPI Number : 1336159631
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE S. PAGE LCSW
Provider Business Mailing Address
First Line : T-9 FORT MISSOULA
Second Line :
City : MISSOULA
State : MT
Zip : 59804-7202
Country : US
Telephone Number : 406-532-8400
Fax Number :
Provider Business Practice Location Address
First Line : 106 W BROADWAY ST
Second Line :
City : BUTTE
State : MT
Zip : 59701-9224
Country : US
Telephone Number : 406-723-5489
Fax Number : 406-782-4020
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2006
Last Update Date : 07/08/2007

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