Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 19 | MT |
Y | 103TC0700X | Clinical Psychologist | 19 | MT |
NPI | 1013110113 |
---|---|
Provider Name | Dr. Janet P. Wollersheim |
First Address | Missoula, MT 59808-5418 |
Second Address | Missoula, MT 59801-6644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 24/09/2009 |