1184995425 NPI number — MS. PATRICIA L. JARACZESKI LAC, BSW

Table of content: MS. PATRICIA L. JARACZESKI LAC, BSW (NPI 1184995425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184995425 NPI number — MS. PATRICIA L. JARACZESKI LAC, BSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JARACZESKI
Provider First Name:
PATRICIA
Provider Middle Name:
L.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LAC, BSW
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:
1184995425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3126 26 4TH ST N
Provider Second Line Business Mailing Address:
GATEWAY COMMUNITY SERVICES
Provider Business Mailing Address City Name:
GREAT FALLS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-727-2512
Provider Business Mailing Address Fax Number:
406-727-7451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 4TH ST. N.
Provider Second Line Business Practice Location Address:
GATEWAY COMMUNITY SERVICES
Provider Business Practice Location Address City Name:
GREAT FALLS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59405-3522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-454-6930
Provider Business Practice Location Address Fax Number:
406-454-6939
Provider Enumeration Date:
01/18/2012

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: 101YA0400X , with the licence number:  830 , 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)





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