MEDICARE: KARIN FODNESS 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	726-LCSW	MT
2	174400000X	Specialist	726-LCSW	MT

General Provider Information

NPI Number	:	1699838193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARIN FODNESS LCSW

Provider Business Mailing Address
First Line	:	235 N 1ST ST W
Second Line	:	STE C
City	:	MISSOULA
State	:	MT
Zip	:	59802-3661
Country	:	US
Telephone Number	:	406-396-2762
Fax Number	:	406-728-5178

Provider Business Practice Location Address
First Line	:	235 N 1ST ST W
Second Line	:	STE C
City	:	MISSOULA
State	:	MT
Zip	:	59802-3661
Country	:	US
Telephone Number	:	406-721-7690
Fax Number	:	406-541-6567

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	09/23/2018

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