Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 348 | MT |
Y | 103T00000X | Psychologist | 348 | MT |
NPI | 1013932813 |
---|---|
Provider Name | Dr. Colleen M Wall-Hoeben |
First Address | Hamilton, MT 59840 |
Second Address | Hamilton, MT 59840-2581 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0491691 | (05) | MT |
S97989 | (02) | MT |