1558348938 NPI number — MS. DIANE V HADDON MSW LCSW

Table of content: MS. DIANE V HADDON MSW LCSW (NPI 1558348938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558348938 NPI number — MS. DIANE V HADDON MSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HADDON
Provider First Name:
DIANE
Provider Middle Name:
V
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW
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:
1558348938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 N HIGGINS AVENUE
Provider Second Line Business Mailing Address:
SUITE 324
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-721-6144
Provider Business Mailing Address Fax Number:
406-721-6709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 N HIGGINS AVENUE
Provider Second Line Business Practice Location Address:
SUITE 324
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-721-6144
Provider Business Practice Location Address Fax Number:
406-721-6709
Provider Enumeration Date:
12/28/2005

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: 1041C0700X , with the licence number:  289LCSW , 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)

  • Identifier: 0000502203 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".