MEDICARE: MRS. MELISSA ANNE CLATER 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	1004	MT
2	1041C0700X	Clinical Social Worker	27004	CA

General Provider Information

NPI Number	:	1942324462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA ANNE CLATER LCSW

Provider Business Mailing Address
First Line	:	2525 S 3RD ST W
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-1328
Country	:	US
Telephone Number	:	406-396-2336
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 S 3RD ST W
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-1328
Country	:	US
Telephone Number	:	406-396-2336
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	06/01/2011

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