MEDICARE: WILD GEESE PSYCHOLOGY PLLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1407717317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILD GEESE PSYCHOLOGY PLLC

Provider Business Mailing Address
First Line	:	1001 S MAIN ST STE 600
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-1498
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 S MAIN ST STE 600
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-1498
Country	:	US
Telephone Number	:	818-645-8810
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTINA B YEAGLEY
Credential	:	PSY.D.
Telephone Number	:	818-645-8810

Provider Enumeration Date	:	11/20/2025
Last Update Date	:	11/20/2025

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