1700160033 NPI number — MRS. ROSEMARY EPPERSON LMSW

Table of content: MRS. ROSEMARY EPPERSON LMSW (NPI 1700160033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700160033 NPI number — MRS. ROSEMARY EPPERSON LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EPPERSON
Provider First Name:
ROSEMARY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700160033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34841 LEMERY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST IGNATIUS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59865-9399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-850-7706
Provider Business Mailing Address Fax Number:
406-676-5582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1313 US-93
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RONAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-850-7706
Provider Business Practice Location Address Fax Number:
406-676-5582
Provider Enumeration Date:
10/05/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  X-07451 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: BBH-LCSW-LIC-11383 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)